A Metabolic Storm
Tragedy in the Operating Room
Department of Biology
West Chester University of Pennsylvania
This "clicker" case presents the true story of a 20-year-old athlete who developed a life threatening reaction to anesthesia during a simple elective surgical procedure. His response was unexpected, but not unusual for individuals who possess an inherited skeletal muscle disorder leading to a condition called malignant hyperthermia because the symptoms only appear in the presence of certain anesthetics. Once the anesthetics act on skeletal muscle proteins, the patient experiences elevated body temperature up to 107°F, muscle rigidity, organ failure, and eventual death if left untreated. Designed for a large enrollment course in human anatomy and physiology or an upper-level physiology course, the case is useful for teaching the events leading to skeletal muscle contraction and relaxation, the importance of ATP and calcium ions in muscle contraction, and how a mutation in a skeletal muscle protein associated with excitation-contraction coupling can lead to malignant hyperthermia. The case is an adaptation of "A Perfect Storm in the Operating Room: Anesthesia and Skeletal Muscle Contractions" by Kelley Grorud published by the National Center for Case Study Teaching in Science (NCCSTS) in 2010.
- Understand the sequence of events that leads to skeletal muscle contraction and relaxation.
- Appreciate the important role of ATP and calcium ions in muscle contraction.
- Know how skeletal muscle generates and uses ATP.
- Explain how a mutation in a skeletal muscle protein associated with excitation-contraction coupling leads to a life-threatening condition called malignant hyperthermia (MH).
- Understand the signs of the condition and treatment strategy for a patient who shows signs of MH in the operating room.
- Learn how patients who suspect they possess themutation can be tested prior to a surgical procedure.
KeywordsSkeletal muscle; excitation-contraction coupling; adenosine triphosphate; ATP; role of calcium and ATP in contraction; malignant hyperthermia; autosomal dominant disorder; ryanodine receptors; Dantrolene; anesthesia
Educational LevelUndergraduate lower division, Undergraduate upper division, Graduate, Clinical education
Type / MethodsClicker, Interrupted, Journal Article
Subject HeadingsCell Biology | Genetics / Heredity | Molecular Biology | Physiology | Medicine (General) | Nursing | Pharmacy / Pharmacology | Sports Science | Biology (General) |
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Teaching notes are intended to help teachers select and adopt a case. They typically include a summary of the case, teaching objectives, information about the intended audience, details about how the case may be taught, and a list of references and resources.
The case requires that students read specified portions of the paper Making Anesthesia Safer: Unraveling the Malignant Hyperthermia Puzzle by Marilyn Green Larach (Breakthroughs in Bioscience, FASEB) at certain points in the case. The paper includes explanations of how malignant hyperthermia was discovered in humans, the animal research that led to an understanding of how the disease works, and the drugs that were designed to treat the disease. Instructors can download a PDF copy of the paper using the link below.
Making Anesthesia Safer (~3.3 MB)