Related Experiment Videos
Should all children with suspected or confirmed malignant hyperthermia susceptibility be admitted after surgery? A
S M Yentis1, M F Levine, E J Hartley
1Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Hospital admission for children susceptible to malignant hyperthermia (MHS) may not be necessary. This study found no MHS-related complications in children undergoing anesthesia without triggering agents, suggesting current admission practices may be excessive.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Medical Genetics
Background:
- Children labeled malignant hyperthermia-susceptible (MHS) are often hospitalized post-surgery, even with uneventful anesthesia.
- Current practices may lead to unnecessary hospital admissions for MHS-susceptible pediatric patients.
Purpose of the Study:
- To evaluate the necessity of hospital admission for MHS-susceptible children after anesthesia.
- To analyze perioperative outcomes in MHS-susceptible children who received anesthesia without triggering agents.
Main Methods:
- Retrospective chart review of 303 MHS-labeled children (431 procedures) between 1981-1990.
- Exclusion of biopsy-negative patients (18 patients, 25 cases).
- Analysis of MHS labeling reasons, perioperative management, and outcomes.
Main Results:
- 58% of procedures resulted in admission solely due to the MHS label.
- No biopsy-proven MHS cases (33 cases) developed intraoperative or postoperative fever.
- Pediatric patients suspected of MHS (10 children) experienced fever, but not attributed to MHS.
Conclusions:
- Postoperative hospital admission solely based on an MHS label is not warranted for children.
- Anesthesia without malignant hyperthermia-triggering agents appears safe for MHS-susceptible children.
- Re-evaluation of current admission protocols for MHS-susceptible pediatric patients is recommended.
Abstract:
Children otherwise suitable for same-day discharge may be admitted to the hospital solely because they are known or suspected to be malignant hyperthermia-susceptible (MHS). To determine whether their hospitalization is necessary, the medical charts of 303 children labeled MHS who had undergone surgery with anesthesia free of malignant hyperthermia-triggering agents on 431 occasions between 1981 and 1990 were reviewed. Eighteen of these patients (25 cases) who were subsequently identified as biopsy-negative were excluded from the study. We recorded the reason for the MHS label and the perioperative management and outcome of the cases. Fifty-eight percent of procedures were followed by hospital admission solely because of the patient's MHS label. None of the 25 children (33 cases) with biopsy-proven malignant hyperthermia developed intraoperative or postoperative pyrexia. Ten children suspected to be MHS developed pyrexia greater than 38.5 degrees C. These episodes were not considered to be malignant hyperthermia and were not treated with dantrolene. None of the remaining 275 patients exhibited any features of malignant hyperthermia, although one had an adverse reaction to radiologic contrast medium. On the basis of our retrospective analysis, postoperative admission to the hospital solely on the basis of the MHS label is not warranted.