Calling for help sounds simple, but its importance
can't be overstated. During an MH crisis you will
need an extra pair of hands to prepare the dantro-
lene while you are taking care of everything else.
In our case, the patient was transferred to inten-
sive care and his surgery was postponed for two
weeks. Genetic testing was sent
immediately after the MH event
and was negative. Therefore, we
obtained a piece of muscle from
the latissimus dorsi that the sur-
geon harvested for the scalp
reconstruction during his re-
scheduled surgery, and we con-
firmed by the caffeine-halothane
contracture test that our patient
was indeed MH-susceptible.
We usually hold morbidity and
mortality meetings whenever
there is a serious complication in
the OR in order to review what
could have been done better. We
did not hold any formal meeting to
discuss this MH incident, as the
outcome was favorable.
Nevertheless, all team members
shared their satisfaction with how
the case was handled, which
encouraged us to maintain our
current response protocols.
The entire incident reinforced
the importance of regular, realis-
tic training. Our staff performs in-
service teaching and hands-on
drills at least once a year. The
teaching and drills involve review-
ing the basics of MH diagnosis
and treatment, as well as getting
familiarized with the crisis
response workflow, the contents
of the MH cart and preparing
dantrolene for administration.
Even though this case ended
with a favorable outcome, I think
it taught the staff valuable lessons
on the importance of prepared-
O
C T O B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 2 5
Dr. Ibarra Moreno (carlos.ibarra@uhn.ca) is a
staff anesthesiologist at Toronto General Hospital –
University Health Network and a consultant for the
Malignant Hyperthermia Investigation Unit.
ness, early recognition and prompt treatment.
Because we were ready, we prevented a crisis from
becoming a catastrophe.
OSM
