HELP! Elective surgery & malignant hyperthermia

[tram523]

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 experience this on my watch. Like I said, I am now an OR nurse for a plastic surgeon. The MD I work for has allowed another MD-plastic surgeon- to use our surgery suite for a 7 hour case. When reading over the H&P, the patient has Central Core Myopathy with risk for MH. I am really upset because my MD is expecting me to be working the OR for this case. I don't want to work this case (in fact, I really don't want to be involved with this other MD at all-and have voiced that to my boss). I feel that this person SHOULD NOT have this surgery and SHOULD NOT have it in a office surgical suite envirnoment (even though we are completely certified, have a MH cart and crash cart, etc). I feel that if the pt. wants this surgery that bad...it should be done in a hospital OR. Am I justified in feeling this way? I'm feeling so much pressure for so many reasons (i.e. safety, job, office staff). Please offer experience,advise, suggestions !!!!

[staceyp413]

Can you request a team walk thru of a mh crisis to see how everyone would react and if you really have the staff, meds, and support? I'd be nervous too but if no other options get prepared and ready for all and hope for nothing.

[eCCU]

1.Check for the presence of the autosomal gene.

2. Consider prophylaxis with dantrolene sodium...it has been known to cause nausea, vomiting and muscle weakness but i gather its better than MH.

3. Be prepared.

4. Make sure the patient its very well aware of this risk!!

[eCCU]

Make sure you document your concerns and if you have safe harbor in your state initiate it to protect yourself incase of a future lawsuits.

[meandragonbrett]

There are anesthetic techniques which are not triggers for MH.

[GHGoonette, BSN, RN]

You are absolutely right; this should be done in a fully equipped theater. Any surgery which takes 7 hours cannot be regarded as "ambulatory". Do you have the facilities there for full anaesthesia? Is a qualified anaesthesia provider going to be present?

As professionals, you and the circulating nurse have the right to advocate for that patient and ensure that he or she is fully aware of the dangers. Other than that, all you can do is follow eCCU's advice and cya.

[TakeTwoAspirin, MSN, RN, APRN]

Why are you fighting this alone? What does the anesthesia provider have to say about this? Ultimately, it is their decision whether or not this patient has the surgery.

[brownbook]

I am confused. I thought MH was only caused by certain specific volatile anesthetic gases given for general anesthesia.

Unless the doctor or anesthesiologists is especially ignorant. Knowing the patients history, they would not even have those specific gases and muscle relaxants in the OR room during that case that can cause MH.

Many plastic surgery cases, even though they are seven plus hours long, are done with no anesthetic gases. It is all intravenous sedation.

Yes MH is deadly serious. As others have said who is the anesthesiologists They would be the ones responsible, but of course you have to be a patient advocate.

[GHGoonette, BSN, RN]

I am confused. I thought MH was only caused by certain specific volatile anesthetic gases given for general anesthesia.

Unless the doctor or anesthesiologists is especially ignorant. Knowing the patients history, they would not even have those specific gases and muscle relaxants in the OR room during that case that can cause MH.

Many plastic surgery cases, even though they are seven plus hours long, are done with no anesthetic gases. It is all intravenous sedation.

Yes MH is deadly serious. As others have said who is the anesthesiologists They would be the ones responsible, but of course you have to be a patient advocate.

Believe it or not, there have been instances where local anaesthetic has triggered MH. TIVA is definitely the way to go where there is any hint of MH in the family medical history, which is why this case should be done in a fully-equipped theater. It's scary, however, to find that certain individuals appear to be getting more and more sensitive to an ever-widening range of substances.

[eCCU]

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 experience this on my watch. Like I said, I am now an OR nurse for a plastic surgeon. The MD I work for has allowed another MD-plastic surgeon- to use our surgery suite for a 7 hour case. When reading over the H&P, the patient has Central Core Myopathy with risk for MH. I am really upset because my MD is expecting me to be working the OR for this case. I don't want to work this case (in fact, I really don't want to be involved with this other MD at all-and have voiced that to my boss). I feel that this person SHOULD NOT have this surgery and SHOULD NOT have it in a office surgical suite envirnoment (even though we are completely certified, have a MH cart and crash cart, etc). I feel that if the pt. wants this surgery that bad...it should be done in a hospital OR. Am I justified in feeling this way? I'm feeling so much pressure for so many reasons (i.e. safety, job, office staff). Please offer experience,advise, suggestions !!!!

Having a patient with hx of myopat, our any muscular disorders like MG puts this patients at a higher risk of developing MH. Most general anesthesia requires volatile agent or neuromuscular blocker those two are major causative agents. Unless the anesthesiologist decides to use only propofol which puts the pt at risk for hypotension. Most propofol only surgeries tend to be quick not more than 4hrs. Either way the problem is that she works for a private practice therefore, being proactive would be the best course of action. Prepare, inform pt, document your findings during your preop assessment and which physicians notified of concerns and their responses, document during procedure and after. Its called defensive documentation:-)

[SandraCVRN]

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.

[brownbook]

Thanks. GHGoonette, geesh......just when you think it is safe........you understand a subject.......the rules get changed.