The reason: This is a difficult call. Sudden death can occur in individ-
uals who present with MH under stressful circumstances like vigorous
exercise and heat stress. Moreover, some individuals who experience
muscle cramping and weakness have been found to be MH suscepti-
bles. Surgery can be very stressful for some patients, despite use of
sedative, analgesic and hypnotic agents like propofol. There is no
guideline or standard that requires facilities to have a MH cart if trig-
gering agents are not in use. However, with the increased recognition
that surgical stress might cause MH without exposure to triggering
agents, I recommend always having stocked MH carts available.
10. Your clinical team can continue to perform surgery
and administer anesthesia after the MH cart has been used and
before it's been restocked.
a. true b. false
Answer: b
The reason: Although nearly simultaneous MH events are unlikely,
this issue is one of preparedness. The reason for checking and main-
taining the MH cart is to ensure that its supplies are available for
every patient under your care. If your facility is small enough — only
1 procedure is performed at a time — it would be best to delay or
postpone the next case until the MH crisis has been completely man-
aged, the patient has been moved to a tertiary care inpatient facility
and the MH cart has been fully restocked.
OSM
O C T O B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 4 3
Dr. Watson (cbwmdct@aol.com) is a consultant and part-time anesthesiologist
with Anesthesia Associates of New London who practices at Lawrence &
Memorial Hospital in New London, Conn.
