Malignant Hyperthermia

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I am making it my goal for my school break to read all threads on this board LOL. I started at the last page and am up to page 79. I came across a post on malignant hyperthermia. I wanted to get your thoughts on something:

When I was 3.5 yrs old I had surgery for bladder reflux. The surgery went awry and lasted (from what my parents told me) for like 10-11 hrs instead of the couple it should have taken. This was at LeBonheur Children's in Memphis and University of TN sent my parents a letter, which I still have here. They wanted my parents to fill out a family questionaire. It said they were studying families of people who had experienced increase in body temp or muscle rigidity during anesthesia and that I was one of those. Apparently they wanted me to participate in some studies but my parents refused. Then another letter states:

"Recently your child had a reaction to anesthesia characteristic of a disease known as malignant hyperthermia. "Malignant" describes the severity of the disease, but there is no connection between "malignant" and cancer. "Hyperthermia" refers to an increase in temperature triggered by anesthetic drugs. The presence of absence of muscle rigidity allows classification of the disease into two categories: rigid and non-rigid. Either may be fatal.

Since MH is an inherited disease, it cannot be "caught" like the flu. The nature of the trait permits MH to skip generations. This explains why a parent of a child with MH may never have an MH reaction.

Identification of an individual susceptible to MH usually is the result of temperature elevation during anesthesia or a faulure of muscles to relax after muscle relaxing drugs. Relatives are notified, informing them the condition exists in their relation. Obtaining personal histories at this stage helps establish a genetic tracing of the disease through past generations.

Prevention of future reactions is very important. Prior to surgery the anesthesiologist must be informed of the condition so a suitable anesthetic procedure can be designed for the patient.

Since malignant hyperthermia, its causes and diagnosis, are not completely delineated, a concrete solution cannot be offered to a patient and his family. Cooperation of family and medical personnel is necessary for any headway to be made in providing assurance to an MH patient.

Some laboratory tests done on blood and muscle tissure are used to aid in the diagnosis. However, in many cases the diagnosis is not firmly established.

In all cases with suspected MH the anesthesiologist and surgeon must be alerted before anesthesia is administered. Blood relatives also need to be aware that they may respond with MH to anesthesia. People with MH are completely normal, as long as they do not receive certain anesthetic agents. Even when they require an anesthetic it is usually possible to avoid agents that trigger MH."

Ok so this is from 1979. I spoke to an the head of anesthesia several years ago when I was pregnant about what to do if I needed anesthesia during delivery. He seemed very fascinated but sort of tried to act like it was no big deal and that it could easily be avoided, and then was like "you probably don't even really have it" Was that to ease my mind? From what I have read here so far, it is still very rare and dangerous.

hmmm... I would not be at risk providing anesthesia would I? Just wanted to get your thoughts on MH and what precautions I should take down the road (in my healthcare career and just my personal healthcare).

Thanks!

SN Mommy

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you need a muscle biopsy and find out for sure what led to the MH, especially if you are planning on administering anesthesia.... where you will be exposed to some MH-drugs. If you have children, it would be helpful to test them as well and if they are positive they should definitely get little bracelets...

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What exactly is involved in a muscle biopsy?

Thanks!

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What exactly is involved in a muscle biopsy?

Thanks!

goto the link www.mhaus.org , your answers to your questions should be there.

Mike

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Thank you for the link. I did read two instances of MH+ anesthesia providers, so that is reassuring. I emailed Dr. Rosenberg for further insight. Hopefully he will respond.

It would really stink if I indeed have MH and it prevented this career path! :o

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Specializes in Gerontological, cardiac, med-surg, peds.

nice article on malignant hyperthermia:

http://www.encyclopedia.com/doc/1g1-19267937.html

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you need a muscle biopsy and find out for sure what led to the MH, especially if you are planning on administering anesthesia.... where you will be exposed to some MH-drugs. If you have children, it would be helpful to test them as well and if they are positive they should definitely get little bracelets...
Now there's an interesting perspective - I never thought about someone with MH working in the OR and having occupational exposure to triggering agents. I wonder if this has been studied anywhere or if MHAUS or OSHA have any guidelines about this?
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Now there's an interesting perspective - I never thought about someone with MH working in the OR and having occupational exposure to triggering agents. I wonder if this has been studied anywhere or if MHAUS or OSHA have any guidelines about this?

There has been one reported case o suspected MH in an OR personnel. However, the exposure to volatile anesthetics by personnel is extremely low due to the rapid turnover of air in the room. It is about 2 ppm (o.0002%) and a study of MH susceptible pigs showed that exposure or 5 ppm or less was highly unlikely to trigger MH. Therefore, it is relatively safe for MH susceptible persons to work in the OR.

In this case I question the likelyhood of true MH. Is was a long 10-11 hr case in a child. It is very likely that the child will have an elevated temperature in the case and shortly thereafter.

SN Mommy, I doubt that you have MH but you can not be sure until you undergo a in vitro contracture test (muscle biopsy). Is it necessary? That depends on your level of anxiety. General anesthesia can usually be avoided and when not possible a non-triggering anesthetic can be given.

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SN mommy,

You should definitely dig into this very deeply.

We are changing breathing circuits after each patient to avoid spreading the "triggers" for MH.

That being said, every single CRNA will be exposed at least once to agents that are considered triggers - b/c your first priority is the patient, and you will let that anesthetic on inadvertently ...

On the bright side, you can work as a CRNA in Endo where they rarely use agents that trigger MH. But to get there, you have to go through the OR, where you will encounter them ... :(

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SN mommy,

You should definitely dig into this very deeply.

We are changing breathing circuits after each patient to avoid spreading the "triggers" for MH.

That being said, every single CRNA will be exposed at least once to agents that are considered triggers - b/c your first priority is the patient, and you will let that anesthetic on inadvertently ...

On the bright side, you can work as a CRNA in Endo where they rarely use agents that trigger MH. But to get there, you have to go through the OR, where you will encounter them ... :(

And wait til do your first sevo mask induction.

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