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Malignant hyperthermia in plastic surgery
P A Wackym1, T J Dubrow, I H Abdul-Rasool
1Department of Anesthesiology, UCLA School of Medicine.
Plastic and Reconstructive Surgery
|November 1, 1988
Summary
Malignant hyperthermia patients can safely undergo plastic surgery. A specific anesthesia regimen avoided triggering hypermetabolic crises in five patients, allowing successful procedures.
Area of Science:
- Anesthesiology
- Plastic Surgery
- Genetics
Background:
- Malignant hyperthermia (MH) is a rare genetic myopathy causing hypermetabolic crises.
- Triggers include potent inhaled anesthetics and depolarizing muscle relaxants.
- MH poses significant risks, leading to reluctance in operating on affected patients.
Observation:
- Five patients with a history of MH underwent plastic surgery.
- Procedures were managed with a specific anesthesia protocol avoiding known triggers.
- Patients were monitored closely for complications.
Findings:
- All five patients received anesthesia with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants.
- No anesthetic or surgical complications occurred during the procedures.
- Post-procedure muscle biopsies confirmed MH susceptibility via caffeine/halothane contracture studies.
Implications:
- This study demonstrates the safety of plastic surgery for patients at risk of malignant hyperthermia.
- Appropriate anesthetic selection is crucial for managing these high-risk patients.
- Safe surgical management can be achieved without prophylactic dantrolene in selected cases.