1. Malignant hyperthermia Some genetically predisposed patients experience a severe reaction, designated malignant hyperthermia, on exposure to certain anesthetics (eg, halothane) and depolarizing skeletal muscle relaxants (eg, succinylcholine). The reaction consists primarily of rigidity of skeletal muscles, hypermetabolism, and high fever. A high cytosolic concentration of Ca2+ in skeletal muscle is a major factor in its causation. Unless malignant hyperthermia is recognized and treated immediately, patients may die acutely of ventricular fibrillation or survive to complain subsequently from other serious complications.

3. Pathophysiology Alteration in the Ca induced ca release via the ryanodine receptor channel (RYR1). After trigger agent is administered, there is a sudden and prolonged release of ca which causes -Massive muscle contraction -Lactic acid production -Increased body temperature -Tachycardia -Increase muscle breakdown

5. Malignant hyperthermia treatment Appropriate treatment is to stop the anesthetic and administer the drug dantrolene intravenously. Dantrolene stops the calcium released by binding to the ryanodine receptor and blocking the opening of the channel. Dantrolene is a skeletal muscle relaxant that acts to inhibit release of Ca2+ from the sarcoplasmic reticulum into the cytosol, thus preventing the increase of cytosolic Ca 2+ found in malignant hyperthermia.

7. Duchenne muscular dystrophy Duchenne muscular dystrophy is a hereditary muscle condition; characterized by progressive skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue. Delayed developmental milestones. Loss of motor skills. Characteristic gait. Calf hypertrophy. Clumsiness/frequent falls. Difficulty climbing stairs or hills. Difficulty rising (Gower’s sign.) Difficulty walking/running.