HELP! Elective surgery & malignant hyperthermia - page 2

I am an OR nurse for a plastic surgeon. I have also worked in an ambulatory surgery center for 5 years in the OR, preop and PACU . I recognize that MH is always a concern during/after surgery but have never had a patient... Read More

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    If you do go ahead with the procedure, one bit of advice. Make sure you have 2 large bore IV's in place and that they are well taped and wrapped. When MH occurs patients sweat A LOT. IV fluid s in the fridge, and ice available.

    Need to run write now but will be back in a few hours to give exaples of some things that happened during a crisis I was in on.

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    Thanks. GHGoonette, geesh......just when you think it is understand a subject.......the rules get changed.
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    Avoid volatile anesthetics. Avoid succinylcholine. TIVA with propofol,remifent, keyamine, etc. rocuronium if muscle relaxant is needed. Nitrous can also be used if needed/desired by the anesthetist.
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    Wow! Thanks for all the responses! This situation is so convoluted because it's not our office's "patient". She's just having surgery at our facility. She hasn't even been at our office yet. I even question the correctness of the H&P that was faxed over. The anesthesiologist said there are anesthetic meds that can be "changed up". This isn't over by far, and more conversations need to take place for sure! Monday is going to be an interesting day And I'm sure there's going to be some upset people. Thanks again everyone!!!!!
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    Hi Tram523,
    I think that is is great that you have assessed the patients record prior to receiving the patient. As others have said, there are two primary triggers for MH, anesthetic gas and Succs (a depolarizing muscle relaxant). These can be avoided rather easily. It is common to do these cases first in the morning (so the anesthesia machine can be flushed of all gas or a separate machine is used) with a total IV anesthetic. Someone mentioned hypotension with propofol injections but I have found these to be no greater than with traditional gas anesthetics. We also use propofol anesthetics for patients with severe PONV, and there is really no limit to the length of the case. These patient will take much longer to wake up from anesthesia than with regular gas. Also, Succs is avoided but other muscle relaxants can be used with no problem. Not knowing the full patient history, it may or may not be a great idea to do this case outside of a hospital setting, but this is highly dependent on anesthesia provider and surgeon comfort levels. It is possible to do this case safely in your setting so please do not panic.

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