patients with known MH susceptibility treated?
Anxiety may contribute to MH crises. Therefore,
some anesthesiologists recommend premedication with anxi-olytics such as
benzodiazepines. Patients experiencing preoperative pain can receive opioids.
Dantrolene premed-ication is no longer necessary and should be avoided in the
pregnant patient because dantrolene crosses the placenta and produces uterine
Either a “clean” machine or an anesthesia
machine in which the oxygen flow has been on at 10 L flow for 20 min-utes
should be used. Iced saline solutions and dantrolene should be available.
Regional anesthesia with either ester or amide local anesthetics may be
preferable to general anes-thesia when possible. General anesthesia may be
induced with propofol, barbiturates,
oxygen, and opioids. Muscle relaxation for tracheal intubation is achieved with
nondepolarizing muscle relaxants such as vecuronium, mivacurium, and
cis-atracurium. The advisability of administering curare is questionable.
Anesthesia mainte-nance is accomplished with total intravenous anesthetics with
or without nitrous oxide. Other acceptable agents include midazolam, diazepam,
and droperidol. Antagonism of neuromuscular blockade may be achieved with
acetyl-cholinesterase inhibitors and anticholinergics.