Zusammenfassung
Die lebensbedrohliche Hyperthermie wird durch eine primär schwere Störung des autonomen Nervensystems einhergehend mit einem Hypermetabolismus der quergestreiften Muskulatur verursacht. Kerntemperaturen erreichen dabei praktisch immer 40 °C und mehr. Auslöser sind in den meisten Fällen Psychopharmaka (Antidepressiva, Neuroleptika), aber auch ein Reihe anderer Medikamente (Antihistaminika, Antibiotika, Parkinson-Mittel, Schmerzmittel) und schließlich volatile Anästhetika („drug induced“). In seltenen Fällen führt Stress, Hitze und körperliche Anstrengung („non drug induced“) zu einem Hyperthermiesyndrom. Die Leitsymptome betreffen das zentrale und periphere autonome Nervensystem (Neurotransmitter) und in praktisch allen Fällen die quergestreifte Muskulatur entweder durch Dysregulation der motorischen Endplatte (Serotonin, Anticholinergika) oder durch intrazelluläre Kalziumüberladung (volatile Anästhetika, Succinylcholin). Die schwere Hyperthermie führt schließlich zu einem Zusammenbruch des autonomen Nervensystems, zu einer Rhabdomyolyse mit Verbrauchskoagulopathie und letzten Endes zum Multiorganversagen. Therapeutisch gelten neben dem Absetzten des auslösenden Agens, je nach Schweregrad, die symptomatologischen intensivmedizinischen Maßnahmen zur Stabilisierung der Organfunktionen. Sie gehen fließend in die Therapie der Multiorgandysfunktion über. Die Therapie des Leitsymptoms Hyperthermie gelingt nur durch physikalische Interventionen beginnend mit einfachen pflegerischen Maßnahmen bis hin zum Einsatz invasiver Kühlsysteme eventuell begleitend von Einsatz nicht depolarisierender Muskelrelaxanzien.
Abstract
Malignant hyperthermia is a life-threatening disease caused by derangement of the autonomic nerve system and hypermetabolism of the peripheral musculature. Commonly body core temperatures of more than 40 °C will be found in this disease which is caused mostly by psychopharmacological drugs like antidepressants, neuroleptics but also antibiotics, pain killers, anti-Parkinson drugs, and volatile anesthetics. The inducers of malignant hyperthermia interact with postsynaptic receptors (serotonin, anticholinergics) or muscular intracellular structures responsible for calcium utilization (volatile anesthetics, succinylcholine). Rarely malignant hyperthermia is a consequence of mental stress or vigorous exercise and or heat. Malignant hyperthermic syndromes lead to a severe dysbalance of the autonomic nerve system accompanied by rhabdomyolysis, disseminated intravascular coagulopathy, and finally multi-organ failure. Accordingly, medical management is primarily directed to stabilize vital functions, withdrawal of the causing drug, and if possible antagonizing toxic substances. The leading symptom hyperthermia needs to be treated physically with available cooling systems.
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Grander, W. Maligne hypertherme Syndrome auf der Intensivstation. Med Klin Intensivmed Notfmed 111, 407–416 (2016). https://doi.org/10.1007/s00063-016-0173-9
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DOI: https://doi.org/10.1007/s00063-016-0173-9