Hi Samad. I've seen a few cases (5 cases) - each one with different outcomes. I had an interesting case that aborted the atypical crisis only changing the anesthesia technique to TIVA, and before the dantrolene came to the OR the crisis was solved.
Dear Claudia, This is what I exactly meant. Why do the texts emphasize on discontinuing all anesthetics while we could use the advantages of continuing Intravenous agents such as their being neuroprotective and so on?!!
Dear Samar, I think that theres is much to discuss on. Specially when you think that most cases will be unconventional and not the classic fulminant crise. When faced to a fulminant cries, I think that there is not much to do besides the general and specific treatment with dantrolene. But in the other atypical cases I agree with you, considering the patient is stable and always telling the surgeon what is happening so the surgical time can be reduced as much as possible. I don't know any experimental work that proposes the anesthetic use after a HM crises concerning to neuroprotection, but when you think in the clinical scenario it is interesting to remeber that all the cases I've seen and heard of did not have any neurological deficit after recovering the acute episode.
What type of triggering agents had you used in your cases? I mean, was it VA or succ that triggered the MH?
In all cases I've been through or also been contacted, VA were involved (iso or sevoflurane).
Fortunately yes for all hospitals I work in! ln São Paulo (Brazil) we have a law that posts every hospital should have avalable dantrolene, if they don't they can be suited... It helped a lot, but there are still some hospitals that do not have dantrolene available...
Hi All
After half a century at work never had never seen never heard (close of me) .
Dantrolene at hand , never used .
Places of work : south France & West Indies .
Thank you dear Jullien. Happy to hear that you never faced MH. By the way, I kinda envy you in that relaxing environment. Hope my retirement ends up in a similar environment!
Hi, After 25 years of practice, I have not seen any case. However, due to the serious outcome, dantroline is always a vailable, and the subject is discussed frequently with trainee.
In 26 years of practice one case of MH occurred. It was caused by sevofluran. After massive increase of endtidal CO2, sevoflurane was stopped, anesthesia was maintained with propfol, the patient was ventilated by an transport ventilator, which was not contaminated by MH triggering substances. Dantrolenene was started immediately and continued for several days until CK normalized. Due to muscular weakness caused by dantrolene weaning from ventilator was difficult. The patient was discharged from ICU without any deficit. Halothan caffeine test to ensure diagnosis was recommended to the patient.