Mh + Cabg

[zippa]

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I know Grey's Anatomy is fictional, but I had a question about tonights episode. They had a patient with malignant hyperthermia. They told him that they couldn't perform a CABG b/c he was "allergic to anesthesia." They decided to do a awake CABG. From my understanding of MH, there are other anesthetics they could give for people with MH. Is this correct?

 

[VentdependenT]

Yes

 

[Ferdie]

yes. I didn't watch tonight's episode, but that show is very outrageous and bad in general.

Last year around this time they had an episode where a woman with 2 uteruses (uteri?) was pregnant with twins - one in each uterus, but due 6 months apart (or something like that. And I think they had 2 different baby daddies too). Well, If you were pregnant in one uterus, that would feedback and suppress ovulation in the whole body, regardless of how many uteri or ovaries or left feet you had. Bottom line: unrealistic.

 

[VentdependenT]

You can do a CABG without intubating the patient. BUT WHY?!

We have an attending from the middle east who has done them without intubation. Thoracic epidural, spinal duramorph with fentanyl, and sedation. Masking the patient during certain portions. Jesus, it just sounds like a friggen mess. Unfortunately, for me only, our cardiac surgeons won't let him pull off the "MAC" heart. I'd like to see it though. Thaz some cowboy $hit.

 

[Ferdie]

You can do a CABG without intubating the patient. BUT WHY?!

you CAN do lots of things

 

[amyl]

i was only paying half attention as i couldn't fall asleep and was hoping greys would put me out. first of all i didn't think the pathogenesis of MH was allergic?!?!? from my understanding inhaled anes and sux cause MH.... i thought the normal procedure for hearts was tons of fentanyl none of that stuff anyways. btw where was the anesthesiologist? the surgeons run the anesthesia?!??!
i mean does this show have a doctor consultant to make sure they don't say stupid medical stuff? if so they need a new one....

 

[brmc]

but just cause you CAN does not mean you SHOULD

 

[dhb]

but just cause you CAN does not mean you SHOULD

Good to see some CRNA's know the concept now it's just a matter of applying it

 

[brmc]

Perhaps you should apply it to yourself as well.

 

[jeesapeesa]

Perhaps you should apply it to yourself as well.

you don't make sense.

 

[brmc]

Perhaps you should apply it to yourself as well.

refer to dhb's comment, perhaps they should apply some restraint on unpleasent rude comments.

 

[Trisomy13]

you CAN do lots of things

i've seen it with fentanyl and scopolamine. no gas the entire case.

 

[BlackSails]

I just watched the episode....god, from shadowing a cardiac anaethesiologist and from lurking on this forum, I could tell you that the entire thing was ******ed. Not noticing MH until after they get up to his heart? Having a CT surgeon doing the stenting? Noticing the MH not by capnography, but by heart rate and rigidity? Having the surgeon notice, rather than the anaesthesiologist?

 

[BlackSails]

During the actual procedure:
Wtf? They dont give him any versed or valium, or anything for sedation? Here: http://jtcs.ctsnetjournals.org/cgi/content/full/125/6/1401 they gave them all versed. Or when his heart rate hits 160, why dont they beta block him? Actually, since the above paper says that the high epidural causes cardiac sympathectomy, wouldnt his heart rate not increase if he were agitated?


And why wouldnt they just use something like propofol + fentatyl and nitrous, with versed and vecuronium? No MH triggering agents, but he still gets GA.

 

[fakin' the funk]

I just watched the episode....god, from shadowing a cardiac anaethesiologist and from lurking on this forum, I could tell you that the entire thing was ******ed. Not noticing MH until after they get up to his heart? Having a CT surgeon doing the stenting? Noticing the MH not by capnography, but by heart rate and rigidity? Having the surgeon notice, rather than the anaesthesiologist?

At my school we take mini-USMLE-Step-2 tests to track our progress during the clinical years. I remember one particularly ludicrous question: "Patient undergoes surgery with halothane anesthesia, during surgery temp goes to 40C. The surgeon notes that the pt is sweating and rigid. 10 minutes later, pt temp is 41C. The anesthesiologist then notes that the PaCO2 is rising. What's your diagnosis?"

Just remember, on any USMLE test, any mention of halothane = MH !

 

[Ferdie]

At my school we take mini-USMLE-Step-2 tests to track our progress during the clinical years. I remember one particularly ludicrous question: "Patient undergoes surgery with halothane anesthesia, during surgery temp goes to 40C. The surgeon notes that the pt is sweating and rigid. 10 minutes later, pt temp is 41C. The anesthesiologist then notes that the PaCO2 is rising. What's your diagnosis?"

...and the next day that anesthesiologist was fired...