EDUCATIONAL COMPUTER SIMULATION OF MALIGNANT HYPERTHERMIA Howard A. Schwid, MD, and Daniel O'Donnell, PhD Schwid HA, O'Donnell D. Educational computer simulation of malignant hyperthermia. J Clin Monk 1992;8:201-208 ABSTRACT. An educational graphic simulator was developed to provide an interactive learning environment to practice the diagnosis and treatment of malignant hyperthermia. The pro- gram incorporates a set of dynamically interacting models to present the physiologic changes associated with malignant hy- perthermia and the simulated patient's response to manage- ment. Cardiovascular, respiratory, and temperature changes are presented through a graphic display of the operating room monitors. Mouse-driven input is used to manage the airway, control ventilation, manage cardiovascular and rhythm dis- turbances, and control fluids, electrolytes, and temperature. Medications, including dantrolene, antidysrhythmics, diuret- ics, and sodium bicarbonate, can be administered. Four simu- lated patients with different presentations of malignant hyper- thermia are included to illustrate variations in the syndrome. Two of these patients are described in detail. KEYWORDS. Hyperthermia, malignant; dantrolene. Measure- ment techniques: mathematics. Monitoring: temperature. THE PROBLEM From the Department of Anesthesiology, RN-10, University of Washington, Seattle, WA 98195. Received Dec 1, 1990, and in revised form Apr 11, 1990. Accepted for publication Sep 5, 1991. Address correspondence to Dr Schwid, Anesthesiology Service (112A), VA Medical Center, 1660 S Columbian Way, Seattle, WA 98108. Malignant hyperthermia (MH) is a life-threatening emergency. When exposed to potent inhalation agents or succinylcholine, the susceptible patient undergoes a dramatic increase in metabolic rate, which causes in- creased 0 2 consumption and CO 2 production. Exces- sive heat production can lead to elevations of tempera- ture up to 46°C. The patient may also manifest cardiac dysrhythmias, severe hypertension, and cardiovascular collapse. Malignant hyperthermia is usually fatal if left un- treated. Cardiac arrest can occur due to metabolic de- rangements, or the patient can experience later sequelae, such as disseminated intravascular coagulation, acute re- nal failure, and pulmonary edema. It is essential that a MH crisis be diagnosed and treated early, before com- plications ensue. Malignant hyperthermia is a genetic disorder with an incidence of approximately 1 per 12,000 pediatric anes- thetic cases and 1 per 40,000 adult anesthetic cases [1]. Due to the low frequency of this syndrome, most anes- thesiologists will encounter very few patients with MH during a lifetime career. Most anesthesiologists will not be exposed to a case of MH during their training or soon afterward. Reading about the syndrome or partici- pating in continuing medical education courses may help prepare anesthesiologists for this emergency, but it is our premise that practicing the management on a simulator may significantly improve training. Copyright © 1992 by Little, Brown and Company 201