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2018, Número 2

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Rev Mex Anest 2018; 41 (2)


Hipertermia maligna. Revisión bibliográfica

Ortega-García JP, López-Ramírez AY

Idioma: Español
Referencias bibliográficas: 46
Paginas: 124-132
Archivo PDF: 214.04 Kb.


RESUMEN

La hipertermia maligna es una miopatía farmacogenética manifestada por una respuesta hipermetabólica con una liberación descontrolada de calcio del retículo sarcoplásmico; puede ser desencadenada en el perioperatorio por anestésicos volátiles y relajantes musculares despolarizantes y de forma extrahospitalaria por actividades físicas extenuantes y calor extremo en personas suceptibles. Su incidencia varía de 1:10,000 a 1:250,000 anestesias. Se han identificado variantes en el receptor de rianodina del músculo esquelético como causantes de más del 70% de los casos de hipertermia maligna a través del gen RYR1 localizado en el cromosoma 19 (19q13.1). La crisis de hipertermia maligna se manifiesta con taquicardia, hipercapnia, rigidez de los músculos maseteros y generalizada, hipertermia que se acompaña de acidosis, hiperkalemia, rabdomiólisis, hipoxemia, insuficiencia renal aguda, arritmias cardíacas, falla cardíaca, paro cardiorrespiratorio y muerte. Los síntomas clínicos son difíciles de identificar, sin embargo, su rápido reconocimiento y tratamiento son cruciales para evitar una evolución fatal. Actualmente el estándar de oro para su diagnóstico es la prueba de contractura de halotano-cafeína, hasta el momento no disponible en México. El tratamiento oportuno con dantroleno sódico ha disminuido notablemente la tasa de mortalidad asociada a esta rara pero fatal enfermedad.


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