Malignant Hyperthermia and Day Stay Surgery

Abstract

Patients who are malignant hyperthermia susceptible are often admitted overnight for observation, even after minor surgery. They may be declined care in a stand-alone day stay unit. This prospective audit set out to investigate whether patients susceptible to malignant hyperthermia can be safely treated as day stay patients. The audit was conducted for four years from late 2000. All patients who were known to be susceptible to malignant hyperthermia, and their untested relatives, who received day stay anaesthesia were included in the audit. Malignant hyperthermia status, age, duration of anaesthesia, anaesthetic technique, type of procedure, intraoperative and postanaesthesia care unit observations and complications were recorded. All patients received a trigger-free anaesthetic technique. Detailed postanaesthesia care unit monitoring was undertaken and patients were observed for two and a half hours postoperatively. Seventy-two patients were included in the audit. General anaesthesia was administered to 85% and regional to 15%. Only minor complications arose in the postoperative period, and none suggested a malignant hyperthermia reaction. Postanaesthesia care unit nursing staff contacted 49 (68%) of the patients the following day, and there was no evidence of malignant hyperthermia reactions. This audit suggests that malignant hyperthermia susceptible patients can be safely managed as day stay patients in appropriate facilities, with appropriate postoperative care.

Safe Duration of Postoperative Monitoring for Malignant Hyperthermia Patients Administered Non-Triggering Anaesthesia: An Update

“…Previously, it was suggested that MHS patients should be monitored for at least four hours in PACU and receive a further 24 hours of inpatient monitoring, even after minor surgery 7,11 but increasingly it is recognised that, with appropriate planning, MHS patients can have anaesthesia in ambulatory surgery centres 12 . Same-day discharge after uncomplicated ambulatory surgery is now considered safe 1,11,13 . Improved anaesthetic and surgical techniques 14 have contributed to this policy, improving the cost-effectiveness of day-case surgery and limiting escalating healthcare costs.…”

Malignant hyperthermia; sterilization monitoring; sterilization indicators; multipack needle counts

“…Nitrous oxide is safe for use as an inhaled general anesthetic, and local anesthetics (eg, lidocaine, procaine) also are safe 2 , 3 . When MH‐susceptible patients undergo uneventful general anesthetics in ASCs, they should be monitored for at least 60 minutes in the phase 1 postanesthesia care unit (PACU) and at least 90 minutes in the phase 2 PACU or step‐down unit before being discharged 1,4,5 …”

“…The patient may be discharged after 10 to 12 hours with instructions to return to an emergency room at the first sign of elevated temperature 3 The patient should be observed overnight if the patient has dark or cola‐colored urine, increased temperature or pulse rate, or changes in acid‐base balance. If the patient had severe jaw rigidity but no other symptoms, the patient should be observed overnight to ensure that there is no progression of symptoms and to decrease the risk of an MH crisis 3–5 …”

“…If the patient had severe jaw rigidity but no other symptoms, the patient should be observed overnight to ensure that there is no progression of symptoms and to decrease the risk of an MH crisis 3–5 …”

Clinical Issues

“…Nitrous oxide is safe for use as an inhaled general anesthetic, and local anesthetics (eg, lidocaine, procaine) also are safe 2,3 . When MH‐susceptible patients undergo uneventful general anesthetics in ASCs, they should be monitored for at least 60 minutes in the phase 1 postanesthesia care unit (PACU) and at least 90 minutes in the phase 2 PACU or step‐down unit before being discharged 1,4,5 …”