...what we know, so far, is that the 18-year old florida patient developed the very rare complication of general anesthesia, malignant hyperthermia, literally "dangerous [color=#006699]elevated temperature". .
...ga is the predominant choice of anesthesia cosmetic surgery, so her surgeon was within the ‘standard of practice' in that choice – expedience over outcomes.
unfortunately, ga or the ‘standard of practice' includes many unnecessary, avoidable and potentially fatal risks to patients choosing to have surgery that has no medical reason or indication.
among those avoidable risks are mh, blood clots to the lungs, airway mishaps leading to lack of oxygen to the patient's brain, postoperative nausea and vomiting (ponv), and postoperative cognitive disorder (pocd).
all of these risks can and should be avoided by having surgeons and patients choose a kinder, gentler anesthetic technique – propofol ketamine or minimally invasive anesthesia (mia)⮠pioneered by friedberg.
neither propofol nor ketamine are triggering agents for mh. had ms. kubela received mia, she would likely be alive today. bis monitoring of the patient's brain gives a numerical value of propofol sedation at which ketamine can be given without negative side effects...
Proof is defined by both basic science and clinical science. There are many papers in the clincal realm that specify propofol does not trigger MH. The basic science paper proves what the clinical science cannot due to lack of sufficient numbers enrolled in clinical trials. Evidence based medicine is a process in which proof is offered through examination of ALL literature, levels I-V NASS or Cochrane levels A-D or one of many other systems. All literature is evaluated, then those with the highest scientific merit are given deference over others. In this realms, the proponderance of evidence is that there is unequivocal proof propofol does not trigger MH. The basic science study is but one of many, but demonstrates through the process of EBM (or in the case of CRNAs, I suppose it would technically be called EBN), how basic science (sorely lacking in the AANA Journal) can provide definitive evidence.
With ketamine, there is conflicting evidence, in far more definitive sources than the level V "opinion" of some professor (level V evidence is completely discounted by most EBM systems when there is more definitive evidence available) . One of the negative association papers is Masui. 1998 Nov;47(11):1296-301. [Effect of ketamine on the Ca(2+)-related functions of skinned skeletal muscle fibers from the guinea pigs]. Nevertheless, the overall level of evidence based on clinical studies for ketamine falls into the inconclusive category due to a lack of studies being published on the subject by CRNAs and anesthesiologists. (Why have you guys not published any studies on this?)
Just two things: 1. When nurses are talking about evidence based research it is EBP (evidenced based practice). We use the term EBP, because it shows that we are open to all research not just research done by people w/ MD or DO behind their names. 2. I will assume there is no reason to do research on ketamine at this point, if one of the U.S.'s biggest MH research facility & faculty don't see a need to do further research on ketamine then what is the point (It wasn't even mentioned as potentially controversial by Dr. Muldoon during her lectures on MH). The research is overwhelming in favor that ketamine is safe to use just like all other known IV anesthetics for MH patients.
FYI: The biggest push for MH research right now is finding a genetic test for MH susceptible patient vs. muscle biopsy, and several of my classmates are involved in that research for their SRNA research project.
wtbcrna, MSN, DNP, CRNA
5,128 Posts
Just two things: 1. When nurses are talking about evidence based research it is EBP (evidenced based practice). We use the term EBP, because it shows that we are open to all research not just research done by people w/ MD or DO behind their names. 2. I will assume there is no reason to do research on ketamine at this point, if one of the U.S.'s biggest MH research facility & faculty don't see a need to do further research on ketamine then what is the point (It wasn't even mentioned as potentially controversial by Dr. Muldoon during her lectures on MH). The research is overwhelming in favor that ketamine is safe to use just like all other known IV anesthetics for MH patients.
FYI: The biggest push for MH research right now is finding a genetic test for MH susceptible patient vs. muscle biopsy, and several of my classmates are involved in that research for their SRNA research project.