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S U R G I C A L
E M E R G E N C I E S
to MH suffers the complication upon each exposure to triggering
anesthetic agents, or at all. Conversely, those who've undergone anesthesia without incident before can't be certain that they're not at risk.
To safely manage MH-susceptible patients, you must first know who
is susceptible. Your anesthesia providers should find out during their
pre-operative assessments whether patients have any family history of
anesthetic deaths and complications.
Case 2: Office Emergency
A healthy 9-year-old girl underwent tonsillectomy and adenoidectomy
in an office-based surgical suite. She had no history of MH or
myopathies in her family. She was induced by mask with sevoflurane,
but needed 20mg of succinylcholine for intubation. Finding her jaw
still tight, the anesthesiologist administered another 20mg. This actually increased the rigidity, but only in the jaw.
He discontinued the sevoflurane and gave mivacurium for relaxation.
The only changes in the patient's vital signs were an increase in endtidal CO2 to 80, attributed to hypoventilation, and a 1-degree rise in
axillary temperature to 100.4°F. The patient began to wake, still intubated. After she was given 1mcg/kg fentanyl, her end-tidal CO2 was
65. The office had no facilities for lab work other than determining
end-tidal CO2. The nearest hospital with a pediatric unit was 5 minutes away, the nearest pediatric intensive care unit 12 minutes away.
The anesthesiologist had dantrolene on hand. He woke the child and
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