Welcome to our archive of questions asked during the last few years of our online discussion featured in SAMBA Talks, our monthly eNewsletter. If you would like to propose a new question for discussion or if you would like to enter an additional comment for a particular question, send us a note. If you are submitting an additional comment, please tell us the question to which the comment belongs.

Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

Preoperative Evaluation/Patient Issues/Should a patient with MH have anesthesia in an ASC?

QUESTION:

Malignant Hyperthermia (MH) is an unusual event but dangerous when it happens. It can develop in any moment of an anesthetic procedure. Does someone have any experience with MH in ambulatory surgery? Is it possible that a patient can develop MH after being discharged to home? Knowing the higher safety of IV anesthetics, does anyone allow patients with known risks to develop MH, to be done on an ambulatory basis if only IV anesthetics are used?

-- From Germán Seckel V., M.D., Los Angeles, Chile

REPLY:

MH can and does occur in any setting where anesthesia trigger agents are administered, be it in a hospital, ambulatory center or office.

I do not believe that MH will occur if the patient has done well for four hours postoperatively and has had no unusual postoperative complaints. However, some rare patients may develop rhabdomyolysis after being discharged, but not the full blown syndrome.

MH susceptibles may have anesthesia in an ambulatory setting. Non trigger agents, local anesthesia, intravenous agents and nitrous oxide may be used without problem. Patients should be monitored for 2-4 hours postoperatively.

Dantrolene sodium should be available wherever MH trigger agents are employed.

-- From Henry Rosenberg, M.D., C.P.E., Livingston, NJ

Does SAMBA have any recommendations on performing surgery and anesthetics on patients at risk for Malignant Hyperthermia? For example, patients with a direct family history of MH or with a muscular disorder like Muscular Dystrophies?

I'm a medical director of a free standing surgicenter, and different anesthesiologists I've asked have differing opinions. What is your opinion?

-- From K. Ando, M.D., Phoenix, AZ

REPLY:

Patients who are MH susceptible or who suffer from muscular dystrophy or other myopathies may be anesthetized with regional or local techniques, with intravenous agents, with non-depolarizing neuromuscular blocking agents and nitrous oxide in combination with narcotics, sedative, hypnotics, etc. However, dantrolene should be available wherever such patients are cared for.

-- From Henry Rosenberg, M.D., C.P.E., Livingston, NJ

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