Malignant Hyperthermia

[yoga crna]

Here is a real situation for the anesthesia students and CRNAs. Perspective students feel free to comment, also.

When I made my pre-op phone calls for cataract surgery yesterday, one of the patients gave me a history of malignant hyperthermia. She had a family member die at 5 years of age durning tonsil surgery. She had a muscle biopsy which was positive for MH. She has had two surgeries, one under general with her temp being elevated and treated with Dantrolene. The second procedure was performed with regional anesthesia, without problem.

My question--would you do her in an ambulatory surgery facility, where general anesthesia is not performed? The is no dantrolene in the facility. The cataracts are performed with topical local by the surgeon and I administer small doses of versed and hold the patients' hand while monitoring them .

What would you do in this situation?

Yoga

PS, I am in private practice, work alone with no medical direction.

Y

]

[Brenna's Dad]

If there are no ports in the tubing, it would be impossible to administer a bolus through that line resulting in a bolus of narcotic.

Is it possible that the PCA pump was set incorrectly?

[London88]

Brenna's Dad,

Where I work, the PCA tubing always has a .9 nss main line attached to it. If a person makes the mistake of pushing a drug through that line, the patient will be bolused.

London88

[CougRN]

Our tubing is the same as London described. So there is always a potential for bolusing if you use that port. Even so that's a small bolus maybe 1-2cc from port to patient. This is a very sad case.

[Scis]

Brenna's Dad,

The medical examiner has already required the pump to be sent off for analysis. She did this the day of the autopsy. Hopefully THE pump was actually sent off by the hospital...

Until the neuro/tox comes back in 2-3 months, we can only speculate, but all these ideas help me since I have no experience with PCA pumps.

My brother survived 8 hours in recovery with the pump in place and I assume he had no problems and remained stable, thus allowing him to be deemed stable enough to transfer to an unmonitored room. The only difference in treatment was the injection administered by the floor nurse.

Does anyone know, when a patient is transferred on a PCA, does the same pump ALWAYS remain intact? I assume it is set up by the pain management people? I am thinking maybe someone transferred the dilaudid onto another pump and did not set that one up correctly?

Like I said, the speculating is agonizing...

[AmiK25]

The PCA is generally set up by the RN caring for the patient. From my experience, the PCA generally travels with the patient and the settings remain the same. I can't imagine that the PACU took the patient to the floor without the PCA and it had to be set up again. When I receive a patient with a PCA I always verify that the settings are correct and I would assume that other nurses do the same thing. However, we all know that mistakes can happen. I am very sorry for your loss....it is a terrible tragedy.

[sloveladyg]

I work in out patient surgery. If I were you I would not advise this person NOT to have surgery in the setting you describe, especially with the family history. . Why even take the risk?