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Elective Management of MH Susceptible Patients
All departments of anesthesia should have a hospital policy and procedures manual for MH cases. Click on each step to view detailed information.
Preoperative
- Premedicate as indicated (optional)
- Perform laboratory tests
- Prepare anesthetic equipment
- Do not use triggering agents
Intraoperative
Postoperative
Preoperative
1. Premedicate as indicated (optional)
Premedication is optional. Pre-operative dantrolene is rarely needed. Other premedication, as for a non MH-susceptible patient, can be used as indicated.
2. Perform laboratory tests
Perform lab tests as needed. Baseline serum CK may be useful.
3. Prepare anesthetic equipment
Prepare the anesthetic equipment - clean, vapour-free anesthetic machine, MH cart. If a dedicated MH anesthesia machine is not available, remove vapourizers (or empty them and tape the dial in the off position), then flush on high flow oxygen for at least 10 minutes, and change circuit and absorbers.
4. Do not use triggering agents
In terms of drugs, do not use succinylcholine or potent inhalation agents. Have sufficient dantrolene (36 vials per adult) on hand.
Intraoperative
1. Monitor temperature continuously
Perform continuous temperature monitoring with axillary temperature probe if possible, otherwise use rectal or esophageal temperature probes.
2. Prepare IV
Use a large bore IV cannula.
3. Perform standard monitoring
Peform standard monitoring including end tidal CO2.
Postoperative
1. Inpatient - monitor temperature and heart rate
Measure temperature and heart rate as per PACU guidelines. There is no need for more frequent monitoring.
2. Outpatient - discharge with instructions
Discharge of ambulatory care patients may be possible when all discharge criteria are met. There is no need to prolong patients stay in the hospital because of their MH status. The patients should be given written instructions that include guidelines for monitoring temperature at home, recognizing the signs of an MH reaction and the emergency contact number from the anesthesia department.
