Guidelines Developed to Manage Malignant Hyperthermia in the Surgical Setting

New guidelines have been developed to aid ambulatory surgical centers (ASCs) in managing malignant hyperthermia (MH), a rare but serious reaction to anesthetics.

The guidelines were developed by a panel of 13 experts representing the Malignant Hyperthermia Association of the United States (MHAUS; Sherburne, NY, USA), along with experts in anesthesia, ambulatory surgery, emergency medicine, and nursing. The panel concluded that every ASC must develop its own specific plan for managing MH, based on individual circumstances. All ASCs must be prepared to administer the muscle relaxant dantrolene as an emergency medication, given intravenously before the patient is transferred. Recent research has shown that for every 30-minute delay in dantrolene treatment, the risk of significant complications of MH doubles.

The guidelines also include a list of potential problems and treatment for each ASC to consider in developing its unique MH transfer plan. Key issues include the capabilities of the transport team and transfer hospital, indicators of patient stability, making the decision to transfer, and coordinating communications. The panel called on each ASC to develop, review, and if needed revise its own MH transfer plan, following estimates that nearly 50 MH events may occur each year in ASCs. The guidelines were published in the January 2012 issue of Anesthesia & Analgesia.

“An ASC may be virtually across the street from a hospital, versus another center that's 50 miles from the nearest hospital,” said lead author Marilyn Green Larach, MD, of Penn State College of Medicine (Hershey, PA, USA). “One of the main thrusts of this effort was to prompt ASCs to develop their own transfer plan, taking into consideration what kind of resources they have and what emergency transport services are like in their areas.”

Malignant hyperthermia is a rare condition in which genetically susceptible people develop rapid increases in body temperature and muscle rigidity in response to certain anesthetics and other drugs. Once MH is recognized, it can be avoided by substituting other anesthetics. However, susceptible patients generally go unrecognized until they (or a family member) experience an episode of MH.

Related Links:
Malignant Hyperthermia Association of the United States