Evidence-Based Patient Safety Advisory: Malignant Hyperthermia

Abstract

Sir: As practitioners in a plastic surgery office-based setting who have successfully managed a patient in a malignant hyperthermia crisis in this setting, we read with great interest the article entitled “Evidence-Based Patient Safety Advisory: Malignant Hyperthermia” by Gurunluoglu et al. [Plast Reconstr Surg. 2009;124(Suppl):68S–81S]. We agree with the authors that it is imperative that all surgeons using general anesthesia in their practice must understand the patient risk of malignant hyperthermia. We also agree, as cited in the references,1–10 that volatile anesthetic gases and succinylcholine are proven malignant hyperthermia–triggering agents. However, we are unable to find scientific evidence in these references to support the authors' claim that d-tubocurarine, phosphodiesterase inhibitors, rapid intravenous potassium, theophylline, and aminophylline are proven malignant hyperthermia–triggering agents, nor did we find discussion in the authors' report or reference for this information to support this position. In addition, the Malignant Hyperthermia Association of the United States that the authors reference and whose protocol to which the authors refer readers for management of malignant hyperthermia does not list these drugs as malignant hyperthermia–triggering agents, and specifically lists curare as a (malignant hyperthermia) safe drug.3 Although there is still much to learn about malignant hyperthermia and exciting research continues, unproven information may confuse practitioners and further complicate and/or compromise successful management of a crisis situation. It is our belief that thorough knowledge of scientifically proven malignant hyperthermia–triggering agents is essential to patient safety and to providing optimal care that minimizes the risks associated with malignant hyperthermia and continual advancement in the care of these patients. Marsha L. Thornhill, M.D. Department of Anesthesia Holy Name Hospital Teaneck, N.J. Richard A. D'Amico, M.D. Department of Plastic Surgery Englewood Hospital Englewood, N.J.

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