As a patient lies on the operating table undergoing a simple surgical procedure, the body temperature suddenly rises and the body goes rigid. The medical team immediately recognizes this as a reaction to the inhaled anesthesia and gives the patient a powerful muscle relaxant and packs the body with ice in order to more quickly lower the rising body temperature. Normal? No, but definitely a rare side effect of inhaled anesthesia.
Malignant hyperthermia is a rare and very dangerous possible complication of inhaled anesthesia. Based on a
Genetic disorder that triggers the body to release uncontrolled amounts of calcium into the muscle cells, this form of hyperthermia can cause a rise in body temperature to 108 degrees in mere minutes. If left untreated, the patient will go into cardiac arrest and could potentially die on the operating table.
A not for profit group, The Malignant Hyperthermia Association of the United States, is a patient run group that operates a hot line available 24 hours a day in order to aid medical professional in the diagnosis and treatment of malignant hyperthermia. Each year, the group received around 650 calls, but this number is thought to be an understatement of the true cases that are suffered each year and left unreported.
While the effects of malignant hyperthermia can occur in any health care situation where anesthesia is used, it is thought that hospitals are safer than office settings due to the constant availability of trained anesthesia professionals that are more able to recognized the symptoms and treat the condition in a timely manner. A recent death in an office setting of a teen undergoing elective surgery has brought this rare condition into the lime light once again.
It has been reported that patients undergoing medical procedures outside of a hospital setting have a higher risk of complications. These complications may include, but are not limited to, infection of the surgery site, blood clots and blood pressure irregularities. Some of these complications may require immediate transfer to a hospital setting in order for the proper care to be administered.
States are not taking these increased risks sitting down. Right now, 24 out of 50 states have regulations in place regarding patients and office setting procedures and more are considering adopting these same type of regulations.
It is advised that patients ask many questions of the professionals in an office setting before undergoing any surgical procedure. Learning about the professionals experience and background is important to the safety of the patient and the success of the procedure.
Malignant hyperthermia was identified more than 30 years ago and today, researchers believe that 1 out of every 300 people may suffer from the genetic mutation causing the life threatening reaction to inhaled anesthesia. After identification, the percentage of deaths from malignant hyperthermia has lowered from 80 % to 5%. This drop in death rate has been directly linked to the use of drugs to lower the calcium levels in the muscle cells quickly and efficiently.
The medication most often used to control the effects of malignant hyperthermia is dantrolene. While hospitals stock this medication on a regular basis, surgical centers may not have the medication on hand and thus do not have the ability to treat the effects of malignant hyperthermia were they to show up during a procedure.
The inhaled anesthesia that most often trigger malignant hyperthermia are cheap and cost effective for the office setting and are thus chosen on a regular basis as the primary means of inhaled anesthesia. These inhaled drugs include halothane, isoflurane, sevoflurane and ether.
There is a safe alternative to these inhaled anethesia. Intravenous sedation with propofol, barbiturates, benzodiazapenes and fentanyl are all safer alternative to the anesthesias.
Patients who have a family member with malignant hyperthermia or
Muscular Dystrophy may be at higher risk of a reaction to anesthesia. All previous medical histories of the patient and the patient's relatives need to be discussed with the anesthesiologist before the surgery begins.
While prevention is always felt to be a better option, the muscle
Biopsy needed to test for malignant hyperthermia can cost more than $6,000.
For more information or support for malignant hyperthermia, The malignant Hyperthermia Association website can be found at
www.mhaus.org .
