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Elective Surgery is Essential - August 2020 - Subscribe to Outpatient Surgery Magazine

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M alignant hyperthermia episodes have been estimat- ed to occur in the general patient population in 1 out of 100,000 administered anesthetics. Even though MH is rare, being ready and prepared to handle a crisis is essential. However, there are many myths about MH that confound aware- ness about the disorder and the best possible treatment meth- ods. Based on my experience as the former medical director of the Malignant Hyperthermia Association of the United States (MHAUS) hotline, these com- mon misconceptions about MH need clarifying. MYTH #1: A post-op fever is indicative of MH FACT: Many clinicians worry that MH may begin in the postoperative period with a fever as the present- ing sign, and anesthesia providers are typically taught that MH can occur as late as 48 hours after surgery. This is incorrect. Postoperative hyperther- mia (a temperature > 38°C) without additional signs of MH is relatively common and is not typically associated with an eventual diagnosis of MH. Nearly all cases of postoperative MH begin to demonstrate signs of onset within 10 minutes of discontinuing the triggering agent (volatile anesthesia gas). MYTH #2: A high fever many hours after administration of succinylcholine is a symptom of MH FACT: A common call we received on the MHAUS hotline involved scenarios similar to this one: An elderly patient with underlying respiratory disease presents to the emergency room with pneumonia and respiratory distress. The docs there determine the patient is in respiratory failure and requires tra- cheal intubation. Etomidate and succinylcholine are administered, intubation is performed and the patient is sent to the intensive care unit to receive further treatment. Later that night, the patient devel- ops a high fever, sometimes exceeding 40ºC. The ICU staff believes a patient with a high fever who received succinylcholine could be experiencing MH. Although the administration of succinylcholine alone is rarely associated with MH, there are no known cases where MH begins to develop many hours later — and manifest solely as a high fever — without additional signs of MH. This patient's uncommonly high fever is most likely related to their underlying infectious process. We are not aware of any of these cases that ultimately proved to be caused by MH. A U G U S T 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 4 1 Malignant Hyperthermia Myth-Busting Refuting common misconceptions about the rare disorder will give your staff the knowledge they need to keep patients safe. Ronald Litman, DO, ML I Philadelphia EXPERT OPINION Ronald Litman, DO, ML, became familiar with common questions about MH during his time as the medical director of the MHAUS hotline.

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