Management of the Malignant Hyperthermia Patient in Ambulatory Surgery

Malignant Hyperthermia (MH) is an inherited muscle disorder characterized by hypermetabolism and triggered by potent volatile anesthetics and the depolarizing muscle relaxant succinylcholine. Clinical signs include hypercarbia, tachycardia, hyperthermia and metabolic acidosis due to abnormal calcium homeostasis resulting in runaway hypermetabolism in the skeletal muscle. Rhabdomyolysis can occur along with disseminated intravascular coagulopathy (DIC) and multi-system organ failure. Early reports of mortality in excess of 70% have been reduced to less than 10% by improved monitoring resulting in early detection and treatment with dantrolene. Management of MH has become well-established and availability of non-triggering anesthetics as well as increased dissemination of information to the anesthetic provider community has decreased the risk as well as the fears of MH-affected individuals. However, the increase in outpatient procedures over the past decade, with procedures often performed in ambulatory care settings where emergency equipment and access to immediate laboratory support may be limited, have increased concern about treatment of unexpected MH crises.