Y
ou never know how your staff will
respond to a rare but potentially
deadly malignant hyperthermia (MH)
event until it actually occurs. When
we found ourselves facing a recent
crisis, our staff stepped up in a major way — and
what we learned from the incident could help
your team's response efforts if they ever wind up
in a similar situation.
Like many MH emergencies, there weren't any
early warning signs. From all outward appearances,
the patient was the ideal candidate to anesthetize.
At 22 years old, he was about to undergo surgery to
remove a malignant scalp tumor. He was otherwise
healthy, did not take any medications and had no
allergies. It took about 45 minutes from the induc-
tion of anesthesia to get the patient positioned and
ready for surgery.
Then it happened.
Just before the initial skin incision was made, the
patient started to develop seizure-like movements.
His muscles became rigid, his heart rate increased
suddenly from 70 to 120 beats per minute and end
tidal carbon dioxide quickly rose from 35 mmHg to
70 mmHg. The anesthesia fellow noticed the early
warning signs of MH and informed the staff anes-
thesiologist, who was also present in the room. The
staff anesthesiologist in turn confirmed the onset of
MH and immediately started the treatment protocol
for which our staff had been trained.
I was called into the room, where I arrived within
two minutes to find out my colleagues had already
appropriately managed the situation. Timing is criti-
cal any time an MH situation is in play. From the
onset of the first sign of trouble until the first dose
of dantrolene was given, it took only nine minutes
2 2 • S U P P L E M E N T
T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 2 0
Carlos A. Ibarra Moreno, MD, PhD, DESA I Toronto
GETTING PREPPED The entire surgical team at Toronto General Hospital readies dantrolene for administration.
We Stopped an MH Crisis in Its Tracks
Quick thinking and a well-trained staff allowed us to identify
and prevent a malignant hyperthermia event in just nine minutes.
All
photos
by
Carlos
A.
Ibarra
Moreno,
MD,
PhD,
DESA