13: Post-Op Fever - Bennett

Question 1

life threatening elevation in body temperature

Answer 1

malignant hyperthermia

• 1/12,000 pediatric anesthetics
• 1/40,000 adult anesthetics

Question 2

etiology of malignant hyperthermia

Answer 2

• inhalation of general anesthetics (halothane)

- combination of muscle relaxants (succinylcholine)

Question 3

theory behind malignant hypothermia

Answer 3

• Sarcoplasmic reticulum contains approx. 3000 times the amount of calcium normally found in the sarcoplasm.
• Normal muscle contraction and relaxation involves the release and resequester of calcium.
• In malignant hyperthermia, the resequester of calcium does not occur.

Question 4

s/s malignant hyperthermia

Answer 4

• Arrythmias
• masseter muscle spasm
• Fever with increased body temp.
• tachypnea and tachycardia
• profuse hyperhydrosis
• metabolic and respiratory acidosis
• hyperkalemia
• abnormal ECG
• elevated CPK

Question 5

non-pharmacological tx malignant hyperthermia

Answer 5

• Stop administration of anesthesia
• Change tubing
• Hyperventilate with 100% o2
• Correction of acidosis
• Cool the patient

Question 6

medication for malignant hyperthermia

Answer 6

DANTROLENE

• • Intra-op 1mg/kg rapid IV push until symptoms subside
• • max dose 10mg/kg
• • post crisis 4-8 mg/kg/day po in 4 doses 1-3 days

Question 7

pre-op prophylaxis malignant hyperthermia

Answer 7

4-8 mg/kg/day po in 4 divided doses
1-2 days preop and last dose 3-4 hrs. pre-op.
Dantrium IV 2.5 mg/kg 1 Hr pre-op

Question 8

body temp ________ during post op period is significant

Answer 8

greater than 100.4 F/ 38 C

Question 9

two causes intraop fever

Answer 9

heat pyrexia or malignant hyperthermia

Question 10

describe heat pyrexia

Answer 10

• occurs during surgery and up to 1 hr post op
• caused by trauma of procedure resulting in inflammation [pyrogenic cytokines]
• increased permeability
• act on anterior hypothalamus and case release of prostaglandins

Question 11

********** Post Op Fever
1-2 d
2-3 d
3-7 d
5-7 d
greater than 7 d

Answer 11

1-2 d = Wind = atelectasis

2-3 d = Water = UTI (or constipation or hematoma)

3-7 d = Wound = infection

5-7 d = Walking = DVT/thrombophlebitis

7+ = Wonder = Drug Fever

Question 12

mediastinum deviates to ______ lung on CXR with atelectasis

Answer 12

affected

Question 13

anytime fever

Answer 13

drug fever
catheter fever
rxn to blood transfusion

Question 14

emergent causes of early post-op fever

Answer 14

• necrotizing STI/myonecrosis
• PE
• alcohol withdrawal
• adrenal insufficiency
• malignant hyperthermia

Question 15

long v. short duration post op edema

Answer 15

short = duration (15-30min.) caused by factors that increase permeability. (serotonin, kinins, prostoglandins)

long = duration (1-2 days) from leakage caused by direct injury. (endothelial destruction)

Question 16

s/s anaerobic infection

Answer 16

• intense pain
• foul smelling
• gas
• necrosis
• brown/black discharge

Question 17

tx infection post op

Answer 17

• decompression
• drainage
• debridement
• antibiotics