Features  |   September 2014
Management of MH in the Ambulatory Environment: Recent Literature That Aids in Diagnosis, Treatment and Outcomes
Author Affiliations
  • Andrew Herlich, D.M.D., M.D., FAAP
    Committee on Ambulatory Surgical Care
Article Information
Airway Management / Ambulatory Anesthesia / Neuromuscular Diseases and Drugs / Pediatric Anesthesia / Pharmacology / Renal and Urinary Systems / Electrolyte Balance / Respiratory System / Features
Features   |   September 2014
Management of MH in the Ambulatory Environment: Recent Literature That Aids in Diagnosis, Treatment and Outcomes
ASA Monitor 09 2014, Vol.78, 28-29.
ASA Monitor 09 2014, Vol.78, 28-29.
Frequently, questions arise as to the necessity of dantrolene availability in the office-based practice or the ambulatory surgery center that does not use volatile agents. Succinylcholine is only maintained in the same facility for airway rescue. In order to answer these important questions, we must turn to available data. Recent additions to the literature have pointed to a greater understanding of malignant hyperthermia (MH) events. Succinylcholine was once thought to be an exceedingly rare trigger of MH events in the absence of inhaled volatile agents. A recent article searched a Canadian database for MH triggers and characteristics.1  The investigators found that succinylcholine was identified as a sole agent trigger in greater than 15 percent of the 129 patients in the database. Additionally, the investigators found that 13 percent of patients had uneventful prior anesthetics. The authors of the Canadian study emphasized that despite the low likelihood of succinylcholine alone triggering MH, dantrolene needs to be stocked for that rare event. The first probability assessment of such an event and the need for dantrolene rescue was a full supply of dantrolene. A newer, 2014 cost-effectiveness assessment of maintaining an amount of dantrolene recommended by the Malignant Hyperthermia Association of the United States (MHAUS) was published, reaffirming the importance of a full supply.2  When compared to the likelihood of a fatal outcome from MH in an ambulatory surgical facility, the availability of dantrolene was deemed to be very cost effective. The authors acknowledged that the study had limitations due to the lack of true long-term data, true incidence of MH and the rates of administration of dantrolene in cases of MH.3  However, the authors emphasized that the fatality of MH prior to the use of dantrolene was acknowledged to be about 80 percent. Since dantrolene therapy was introduced, the case fatality of MH decreased to 10 percent. Current estimates suggest that the case fatality may be even less than 5 percent due to improved patient monitoring and availability of dantrolene.4 
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