Features  |   August 2013
Malignant Hyperthermia in the ASC and Office-Based Setting: Recent Developments in Preparation and Management
Author Affiliations
  • Andrew Herlich, D.M.D., M.D., FAAP
    Committee on Ambulatory Surgical Care MHAUS Consultant
Article Information
Ambulatory Anesthesia / Patient Safety / Features
Features   |   August 2013
Malignant Hyperthermia in the ASC and Office-Based Setting: Recent Developments in Preparation and Management
ASA Monitor 08 2013, Vol.77, 26-27.
ASA Monitor 08 2013, Vol.77, 26-27.
The unexpected triggering of malignant hyperthermia (MH) in an ambulatory surgery center (ASC) or office-based setting is unnerving. Despite routine MH mock drills in these settings, an MH episode is one of the least expected and most feared crises. Fortunately, a recent cooperative effort from the Malignant Hyperthermia Association of the United States (MHAUS), Society for Ambulatory Anesthesia (SAMBA), the Ambulatory Surgery Foundation, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians has created an orderly guideline/algorithm for treatment and transfer to an acute care facility.1  The guideline was created to address the variability of ambulatory facilities, receiving hospitals and available personnel. What was clearly drawn from other experiences was the fact that the grab-and-go approach without stabilization of the MH patient would have unfavorable outcomes.1  The grab-and-go approach is most frequently used in the pre-hospital care environment. In contrast, inter-facility transfer required greater control of the MH crisis. Administration of an initial dose of dantrolene and greater efforts of overall stabilization were deemed to be highly important. Complete stabilization may not be practical and should not delay the transfer of the MH patient to the acute care facility. A similar approach was created for MH in the office-based environment. Posters and forms are available from MHAUS to assist the ASC and office practice in the management of MH and appropriate transfer to an acute care facility. There are specific forms and posters for both the ASC and office-based environment. In all instances, after initiation of treatment, early calls to the MHAUS Hotline (1-800-MH-HYPER or 1-800-644-9737) and 911 will help with the orderly transfer. MH Hotline consultants will help guide treatment and answers questions during the crisis. Early calls to EMS will expedite emergent transfer to the receiving facility with most appropriate personnel to continue treatment.
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