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.
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