Masseter Muscle Rigidity and Malignant Hyperthermia Susceptibility in Pediatric Patients An Update on Management and Diagnosis

O'Flynn, Richard P.; Shutack, John G.; Rosenberg, Henry; Fletcher, Jeffrey E.

doi:10.1097/00000542-199406000-00009

Cited by 80 publications

(31 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study used one-way ANOVA whereas the researcher in McCarthy s study used unpaired t-test. Additionally, this does not correlate with the study conducted by O Flynn et al (1994). In that study, all of the 70 patients developed clinical signs of MH within ten minutes.…”

Section: Discussionmentioning

confidence: 67%

“…Other findings in the patients in the study conducted by O Flynn and associates (O Flynn et al, 1994) was that a significant number of patients developed arterial carbon dioxide tension greater than 50 mm Hg with adequate controlled ventilation, arterial pH less than 7.25 and a base deficit of greater than 8 meq/L. From these studies it seems apparent that hyperthermia is a very late sign in MH, whereas increased carbon dioxide production seems to occur very early.…”

Section: Other Findingsmentioning

confidence: 82%

“…The enflurane group did not have a patient developing MMR and the halothane group had the highest percentage (47.0%). According to O Flynn et al (1994), the overall incidence of masseter muscle rigidity occurs in 0.3-1.0% of all pediatric patients receiving halothane and succinylcholine. The incidence here is much higher than those statistics and may reflect the fact that no distinction was made as to whether or not the patient received succinylcholine versus a group of patients not receiving succinylcholine.…”

Section: Discussionmentioning

confidence: 99%

“…Their recommendation based on research done on 57 children with isolated MMS indicated that anesthesia did not necessarily have to be discontinued in those cases, provided careful monitoring accompanied diagnostic evaluation. In the study conducted by O Flynn, Shutack, Rosenberg, & Fletcher (1994), a high incidence of patients with masseter muscle rigidity (MMR) tested positive for MHS. This particular study evaluated 70 pediatric patients being seen for muscle biopsy based on evidence of MMR after succinylcholine.…”

Section: Pathophysiology and Clinical Presentationmentioning

confidence: 99%

See 3 more Smart Citations

Differences in the Onset and Severity of Symptoms of Malignant Hyperthermia with Different Inhalational Anesthetics

Solberg¹

1999

View full text Add to dashboard Cite

Malignant hyperthermia (MH) is an uncommon inherited disorder of skeletal muscle in which commonly used anesthetics can trigger sustained skeletal muscle hypermetabolism in patients who may have had no symptoms previously. The onset and severity of clinical symptoms of MH are variable. Non-clinical studies and case reports have identified differences in the onset and severity of symptoms with the commonly used volatile anesthetics. The purpose of this study was to identify if there is a significant difference in the onset and severity of signs and symptoms of malignant hyperthermia in those MH-susceptible patients who received the different volatile anesthetics. A comparative descriptive research design was used. A retrospective review of the database at the (USUHS) MH muscle biopsy diagnostic center was done. The data collected was used to determine if there was a difference in the onset and severity of signs and symptoms of MH episodes with halothane compared to MH episodes of four other volatile anesthetics. For each of these groups, the following variables were assessed: highest temperature, highest end-tidal carbon dioxide, time from beginning of anesthetic until onset of first MH symptom, time of onset of anesthesia until initial treatment for MH, and the incidence of masseter spasm. Based on results of this study, there was no significant difference among the groups. As much of the pediatric data was excluded, the results may have been skewed. Further studies examining these differences between volatile anesthetics would be extremely valuable in understanding the pathophysiology of malignant hyperthermia.

show abstract

Section: Discussionmentioning

confidence: 67%

Section: Other Findingsmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Pathophysiology and Clinical Presentationmentioning

confidence: 99%

See 2 more Smart Citations

Differences in the Onset and Severity of Symptoms of Malignant Hyperthermia with Different Inhalational Anesthetics

Solberg¹

1999

View full text Add to dashboard Cite

show abstract

“…9,10 In summary, it seems the association between strabismus and MH is no longer an issue; however, if MMS is suspected in a patient, it is important to recognize that this patient may be susceptible to MH. 9,12 The importance of a detailed anesthetic family history is emphasized.…”

Section: Methodsmentioning

confidence: 99%

Anesthetic management for pediatric strabismus surgery: Continuing Professional Development

Rodgers

Cox

2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose Strabismus surgery is one of the most common pediatric ophthalmic procedures. The purpose of this continuing professional development module is to update physicians on the anesthetic considerations of pediatric patients undergoing strabismus surgery. Principal findings The preoperative assessment is important, as patients undergoing strabismus surgery may have an associated neuromuscular disorder, congenital syndrome, or cardiac disease. Malignant hyperthermia is no longer considered as being an issue associated with strabismus. The laryngeal mask airway is used frequently and has been shown as being associated with a low incidence of complications in strabismus surgery. The anesthesia technique can be adapted to decrease the incidence of the oculocardiac reflex and the oculorespiratory reflex, and the use of anticholinergic prophylaxis remains debatable. Since patients are at high risk for postoperative nausea and vomiting (PONV), combination anti-emetic therapy is recommended using dexamethasone and ondansetron. Metoclopramide was not found to provide additional benefit when combined with other anti-emetics. Droperidol is effective, but there remains a black box warning for dysrhythmias. Effective analgesics in this patient population include acetaminophen, nonsteroidal anti-inflammatory drugs, peribulbar blocks, and subtenon blocks. Topical tetracaine drops have demonstrated mixed results, and topical nonsteroidal anti-inflammatory drops were found not to be effective. The use of opioids should be minimized due to the increased incidence of PONV. Conclusions To provide optimal care for the pediatric patient undergoing strabismus surgery, it is important to understand the unique anesthetic considerations for strabismus surgery and to appreciate how each decision regarding the anesthetic technique can alter these considerations. Objectives of this continuing professional development (CPD) moduleUpon completion of this CPD module, the reader will be able to:1 Perform a thorough preoperative assessment with an emphasis on the co-existing diseases and syndromes with ocular manifestations; 2. Evaluate the possibility of an increased incidence of masseter muscle spasm or malignant hyperthermia in this patient group; 3. Detail an anesthetic plan for strabismus surgery, including airway management and choice of anesthetic agents; 4. Understand the mechanism of the oculocardiac and the oculorespiratory reflex and recognize the associated risk factors and treatment; 5. Determine the analgesia options for strabismus surgery; and 6. Plan evidence-based anti-emetic prophylaxis for strabismus surgery. Summary reviewStrabismus surgery is the most common pediatric ophthalmic procedure. 1,2 The purpose of this continuing professional development module is to review the unique anesthetic issues facing a patient presenting for strabismus surgery. It is important to be aware of specific issues, such as the association with specific syndromes and diseases, the occurrence of the oculocardiac reflex, and the increas...

show abstract

Medical Conditions Influencing Anesthetic Management

Lerman¹,

Coté

Steward

2016

Manual of Pediatric Anesthesia

View full text Add to dashboard Cite

Masseter Muscle Rigidity and Malignant Hyperthermia Susceptibility in Pediatric Patients An Update on Management and Diagnosis

Cited by 80 publications

References 0 publications

Differences in the Onset and Severity of Symptoms of Malignant Hyperthermia with Different Inhalational Anesthetics

Differences in the Onset and Severity of Symptoms of Malignant Hyperthermia with Different Inhalational Anesthetics

Anesthetic management for pediatric strabismus surgery: Continuing Professional Development

Medical Conditions Influencing Anesthetic Management

Contact Info

Product

Resources

About