Does the history of malignant hyperthermia preclude an office-based procedure and anesthesia?

Does the history of malignant hyperthermia preclude an office-based procedure and anesthesia? How should you prepare for an untoward event?

While the incidence of malignant hyperthermia is low, the occurrence of an episode of malignant hyperthermia in the office poses many problems unique to this setting. The resuscitation effort involved in malignant hyperther-mia is quite complicated and labor-intensive and there may not be enough experienced personnel to run such an effort.

If triggering agents of malignant hyperthermia are to be used, the facility should have the resources necessary to begin the initial treatment of an event. This includes having at least enough dantrolene to treat a 70 kg patient for the initial intravenous dose (36 vials) while the patient is being transferred to a tertiary care facility. The emergency cart should contain sterile water, syringes, sodium bicarbonate, mannitol, lidocaine, procainamide, 50% dextrose, cold normal saline, and insulin.