Malignant Hyperthermia Preparation for ASCs

Help is available on the MHAUS website BY ROBERT KURTZ


iona Stephan, RN, considers her ASC—Vanguard Surgical Center

in Maywood, New Jersey—fortunate. It has never experienced a malignant hyperthermia (MH) event. That could, however, change at any time without warning, she says. “You do not know when an MH

event will occur,” says Stephan, Van- guard’s administrator and director of nursing. “That makes preparation extremely important. If an event were to occur, we would go into crisis mode. Everyone on our surgical team has an integral role. We would work together to have a successful outcome.” MH, an inherited disorder that

affects calcium regulation within the muscle cells, is triggered by the admin- istration of the injectable drug succi- nylcholine or any of the volatile inha- lation anesthetic agents that could be used during surgery, including sevoflu- rane, desflurane, isoflurane and halo- thane, says David M. Shapiro, MD,

CASC, former ASCA Board president and anesthesiologist at Red Hills Sur- gical Center in Tallahassee, Florida. “An understanding of this condition and its triggers is critical to developing an ASC’s approach to MH,” he says. Both awareness and preparation are cru- cial to facilitating a successful response to an episode of MH. That awareness begins with an understanding of the genetic nature of the predisposition to MH, and of the triggering agents which commonly precipitate an episode. “Practitioners are well advised to query their patients regarding any prior his- tory of anesthetic-related issues, either concerning themselves or among fam- ily members. Even if the histories are negative for any symptomology sugges- tive of MH, it is nevertheless still cru- cial to be diligent about intraoperative monitoring of temperature and end tidal carbon dioxide.”

A successful outcome following an MH event is the saving of a patient’s


life and avoiding other serious harm, such as organ damage, says Joseph Tobin, MD, treasurer and member of the board of directors for the Malig- nant Hyperthermia Association of the United States (MHAUS). “You are looking at a situation where a patient goes from seemingly good health to developing a life-threatening disease in a matter of minutes,” says Tobin, who also is the former chairman of anesthesiology at the Wake Forest School of Medicine in Winston-Salem, North Carolina. “While most patients who have undergone surgery and received general anesthesia with a para- lyzing agent in the past are not likely to experience an MH event, we know of at least one patient who underwent 30 sur- geries and then experienced MH. This demonstrates the importance of main- taining the level of preparation required for a fast, appropriate response.”

Prioritize Patient Transporting Time is of the essence when an MH event is suspected, Shapiro says. When you believe a patient is experiencing MH, that’s when you should expedi- tiously begin to initiate the treatment protocol, he says. “While the patient is being stabilized, it is advisable to have someone in the facility concurrently arranging transportation and treatment subsequent to transfer.”

Proper preparation requires iden- tifying in advance where an ASC will transfer such patients, Tobin says. “Develop a transport policy that clearly identifies the authorizing and receiving hospital.” ASCA and MHAUS developed a

poster, “The Transfer Plans for Suspected MH Patients,” in 2010, and revised it in 2019. Visit the MHAUS website,, for more information.

Building the Cart When an MH event occurs, ASCs must be prepared to initiate treatment quickly. The drugs, supplies and equip- ment required for such treatment are typically stored on a cart that can be brought over to the patient experienc- ing MH (learn what MHAUS recom-

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