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Elective Management of MH Susceptible Patients


All departments of anesthesia should have a hospital policy and procedures manual for MH cases. Click on each step to view detailed information.


Preoperative

  1. Premedicate as indicated (optional)
  2. Perform laboratory tests
  3. Prepare anesthetic equipment
  4. Do not use triggering agents

Intraoperative

  1. Monitor temperature continuously
  2. Prepare IV
  3. Perform standard monitoring

Postoperative

  1. Inpatient - monitor temperature and heart rate
  2. Outpatient - discharge with instructions

Preoperative

1. Premedicate as indicated (optional)

Premedication is optional. Pre-operative dantrolene is rarely needed. Other premedication, as for a non MH-susceptible patient, can be used as indicated.

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2. Perform laboratory tests

Perform lab tests as needed. Baseline serum CK may be useful.

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3. Prepare anesthetic equipment

Prepare the anesthetic equipment - clean, vapour-free anesthetic machine, MH cart. If a dedicated MH anesthesia machine is not available, remove vapourizers (or empty them and tape the dial in the off position), then flush on high flow oxygen for at least 10 minutes, and change circuit and absorbers.

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4. Do not use triggering agents

In terms of drugs, do not use succinylcholine or potent inhalation agents. Have sufficient dantrolene (36 vials per adult) on hand.

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Intraoperative

1. Monitor temperature continuously

Perform continuous temperature monitoring with axillary temperature probe if possible, otherwise use rectal or esophageal temperature probes.

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2. Prepare IV

Use a large bore IV cannula.

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3. Perform standard monitoring

Peform standard monitoring including end tidal CO2.

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Postoperative

1. Inpatient - monitor temperature and heart rate

Measure temperature and heart rate every 1 hour for 4 hours and then every 4 hours for 24 hours.

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2. Outpatient - discharge with instructions

Discharge of ambulatory care patients may be possible (after 4 hours) providing all discharge criteria are met. The patients should be given written instructions that include guidelines for monitoring temperature at home, recognizing the signs of an MH reaction and the emergency contact number from the anesthesia department.


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