Malignant Hyperthermia Limitations?

[menaniac]

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Sorry to post here, but I think you guys might have a better answer for this than the general SDN public. I'm a starting MS1 who is malignant hyperthermic. I am wondering if this will affect me when I'm doing surgery rotations, or if I become interested in anesthesiology. Does anyone know if being in the OR would be detrimental to MH people? Sitting over the gas as its administered? I know this is a kind of weird question, and I'm not losing too much sleep over it yet, but I am very curious. Maybe there's not a big enough sample set to determine an answer? Just wondering your thoughts...Thanks!🙂

 

[BLADEMDA]

Sorry to post here, but I think you guys might have a better answer for this than the general SDN public. I'm a starting MS1 who is malignant hyperthermic. I am wondering if this will affect me when I'm doing surgery rotations, or if I become interested in anesthesiology. Does anyone know if being in the OR would be detrimental to MH people? Sitting over the gas as its administered? I know this is a kind of weird question, and I'm not losing too much sleep over it yet, but I am very curious. Maybe there's not a big enough sample set to determine an answer? Just wondering your thoughts...Thanks!🙂

Your exposure during Surgery rotations should be minimized by avoiding exposure to the inhalational agents during induction and wake-up. Your biggest risk is during Pediatric Inductions where Inhalational gas exposure is usually used at high levels with a face mask.

As far as choosing Anesthesiology as a career choice I would look elsewhere as the risk just isn't worth it. A very interesting question that deserves a thorough literature search.

Blade

 

[BLADEMDA]

Prior to starting your Surgery Rotation I would go to your medical library and read this article ASAP.

Anaesthesia 2001 Oct;56 (10) 1029 Anesthesiology Career for a MH person?

If you can get it here is another:
JR Army Med Corps
1996 Feb;142 (1):30-1

Your history warrants a cautionary approach to ANY exposure of inhational agent in the operating room. Are you 100% positive that you have Malignant Hyperthermia? Biopsy proven or history of MH as a child? If you are not POSITIVE of the diagnosis you may need a muscle biopsy and a CALL to the MH hotline for more advice.

www.MHAUS.org or 1-800-644-9737

Blade

 

[Noyac]

You should be fine in most scenarios since the average OR has about 2 ppm of volatile agents floating around at any one time. This is due to the high turnover rate of the OR atmosphere. The generally understood amount of volatile agent necessary to trigger MH is above 5ppm.

But with this being said, I would seriously consider not doing anesthesia as Blade said.

 

[menaniac]

Prior to starting your Surgery Rotation I would go to your medical library and read this article ASAP.

Anaesthesia 2001 Oct;56 (10) 1029 Anesthesiology Career for a MH person?

If you can get it here is another:
JR Army Med Corps
1996 Feb;142 (1):30-1

Your history warrants a cautionary approach to ANY exposure of inhational agent in the operating room. Are you 100% positive that you have Malignant Hyperthermia? Biopsy proven or history of MH as a child? If you are not POSITIVE of the diagnosis you may need a muscle biopsy and a CALL to the MH hotline for more advice.

www.MHAUS.org or 1-800-644-9737

Blade

Thanks for all the great info Blade! I'm 90% certain that I'm MH...after the 2nd surgery I had high fever (109), discolored urine, was was generally very sick for several days afterward. They didn't diagnose me then, but did just before my 3rd surgery by my previous symptoms. Good thing, too. They used the "special" anesthesia for MH people, and I didn't have much trouble post-op that time. You are right that a muscle biopsy would be a good idea. This just never occured to me as being vital until I decided to go to med school. Time to get that in motion! Thanks for all your help!

-Menaniac

 

[BLADEMDA]

You should be fine in most scenarios since the average OR has about 2 ppm of volatile agents floating around at any one time. This is due to the high turnover rate of the OR atmosphere. The generally understood amount of volatile agent necessary to trigger MH is above 5ppm.

But with this being said, I would seriously consider not doing anesthesia as Blade said.

Noy,

I can tell you I have gotten some serious SEVO in my face during Pediatric Inductions. You never know in our field when some idiot is going to leave a vaporizer open or improperly closed. It happens to me every few months when I go to turn on a vaporizer the TECH didn't close the filling port and the GAS leaks everywhere.

It seems risky for someone with KNOWN MH to choose Anesthesiology. There are SO Many other great specialties out there with a MUCH better safety profile for that individual.

This would be like SUPERMAN choosing to MINE Kryptonite for a living.


Blade

 

[dhb]

This would be like SUPERMAN choosing to MINE Kryptonite for a living.
Blade

"This is due to the high turnover rate of the OR atmosphere." this is true but i think 95% of the air is recycled into the OR so if someone leave the vaporizer open you might get levels higher than that 2ppm average

 

[Noyac]

ABSOLUTELY,

Thats why I said that I would seriously consider not doing anesthesia.

There has only been one documented case of MH in OR personnel. It was someone cleaning up a spill of one of the volatile agents. Thats it just one. That I know of at least.

dhb, I really doubt that the recirculation of the OR air would be an issue. It needs to increase the ppm to 5 or over to be of any significant risk.

 

[menaniac]

Thanks for all your advice everyone! I'm planning on actually having the muscle test for MH done, and I've already contacted one of the programs to get that ball rolling. Great advice, and soon we'll see what's really going on (though I really do suspect the original diagnosis was right-on). Better to know for sure, than base important decisions on assumptions! Thanks again! 😀

 

[Fastrach]

I asked an attending about this today, and he said he'd definately recommend an MH susceptible individual NOT go into Anesthesia. Supposedly there are case reports of MH triggering events even in the PACU, just from being around a lot of people still blowing off their inhaled agents. Crazy, but true.

 

[Noyac]

I asked an attending about this today, and he said he'd definately recommend an MH susceptible individual NOT go into Anesthesia. Supposedly there are case reports of MH triggering events even in the PACU, just from being around a lot of people still blowing off their inhaled agents. Crazy, but true.

I find that hard to believe. Can you provide support to this statement? It is very unlikely. Were they doing mouth to mouth?

 

[Fastrach]

I find that hard to believe. Can you provide support to this statement? It is very unlikely. Were they doing mouth to mouth?

May have just been anecdotal, but I'll see if I can dig up a reference. Agreed, it would be difficult to parce out the details to know for sure, but I don't find it hard to believe at all, given how our PACU usually smells like an open Sevo tank on a busy morning.

 

[menaniac]

I've pretty much decided that anesthiology would probably not be the best field for me to enter, but what are your thoughts on surgery? This is what I am primarily interested in (though as an MS1 that could change). Could just being around the OR for prolonged periods be dangerous? I'm going to be very bummed if that's the case! I'm also thinking how it could potentially impact my clerkships later on...a surgery med student who can't be in the OR wouldn't do very well, I'd assume! As bummed as I'd be, though, I'd rather not risk my life for it if there will be potential problems.

What do you guys think? You've been a lot of help already!

PS. I'm still waiting for the MH testng center near me to get back to me about a muscle test. It would be a sweet surprise if the whole issue was moot, but in looking more deeply into the "awake symptoms" that they list on their site, I've got a whole bunch of those too. Looks like I'm going to be wearing one of those cool bracelets after all! 😉

 

[Planktonmd]

I've pretty much decided that anesthiology would probably not be the best field for me to enter, but what are your thoughts on surgery? This is what I am primarily interested in (though as an MS1 that could change). Could just being around the OR for prolonged periods be dangerous? I'm going to be very bummed if that's the case! I'm also thinking how it could potentially impact my clerkships later on...a surgery med student who can't be in the OR wouldn't do very well, I'd assume! As bummed as I'd be, though, I'd rather not risk my life for it if there will be potential problems.

What do you guys think? You've been a lot of help already!

PS. I'm still waiting for the MH testng center near me to get back to me about a muscle test. It would be a sweet surprise if the whole issue was moot, but in looking more deeply into the "awake symptoms" that they list on their site, I've got a whole bunch of those too. Looks like I'm going to be wearing one of those cool bracelets after all! 😉

I am sure there are many people who are susceptible to MH already working in OR's around the world or even giving anesthesia without knowing it.
You will have the advantage of knowing it.
No one can tell you it will be safe 100 %, but If that's what you want to do then the best way to find out is trying it.

 

[BLADEMDA]

I've pretty much decided that anesthiology would probably not be the best field for me to enter, but what are your thoughts on surgery? This is what I am primarily interested in (though as an MS1 that could change). Could just being around the OR for prolonged periods be dangerous? I'm going to be very bummed if that's the case! I'm also thinking how it could potentially impact my clerkships later on...a surgery med student who can't be in the OR wouldn't do very well, I'd assume! As bummed as I'd be, though, I'd rather not risk my life for it if there will be potential problems.

What do you guys think? You've been a lot of help already!

PS. I'm still waiting for the MH testng center near me to get back to me about a muscle test. It would be a sweet surprise if the whole issue was moot, but in looking more deeply into the "awake symptoms" that they list on their site, I've got a whole bunch of those too. Looks like I'm going to be wearing one of those cool bracelets after all! 😉

Did you get those articles I listed for you? Here is my advice based on a paternalistic attitude. If you were my kid or relative I would encourage a field outside the operating room area. THere are many to choose from including the medical subspecialties. Even those specilaties have an occasional exosure to anesthesia vapor but on rare occasions (Cath lab case with GA, GI case with GA, etc.). A more manageable risk/benefit curve for you.

Why increase the risk to your life? Then again, after seeing those extreme sports shows on cable some people like to live life on the edge. Ultimately, it is your decision but once you have a family of your own to worry about the additional risk may not seem worth it.

Blade

 

[menaniac]

Did you get those articles I listed for you? Here is my advice based on a paternalistic attitude. If you were my kid or relative I would encourage a field outside the operating room area. THere are many to choose from including the medical subspecialties. Even those specilaties have an occasional exosure to anesthesia vapor but on rare occasions (Cath lab case with GA, GI case with GA, etc.). A more manageable risk/benefit curve for you.

Why increase the risk to your life? Then again, after seeing those extreme sports shows on cable some people like to live life on the edge. Ultimately, it is your decision but once you have a family of your own to worry about the additional risk may not seem worth it.

Blade

I'm waiting for them to come in over Interlibrary Loan. I'll take a look at them when they come in and see what they say.

Thanks for all your help! I'm just trying to assess the risk before I make any huge decisions. I've always been interested in surgery, so I guess I'm grasping at straws. I wouldn't want to give up on a dream before looking at all the information, and getting advice from as many knowledgeable people as possible. Then again, I have several years before this becomes an urgent issue, so I'm trying not to worry about it too much.

Thanks again for everything! 🙂

 

[Pianoboe01]

I am in a similar situation. My aunt developed MH and my mother is muscle biopsy positive, so I have a 50% chance of being positive. I am on my MSIII anesthesia rotation right now and posed the OP's question to my school's program director, and he referred me to the MHAUS Consensus Statement for MHS OR Personnel http://medical.mhaus.org/index.cfm/fuseaction/Content.Display/PagePK/ConsensusStatementOR.cfm which states that "there is no evidence to support restricting the professional choices of MHS individuals." However, he was still on the cautious side and made sure I was not assigned to the pediatric hospital where they do a a high number of inhaled inductions which could produce a higher OR concentration of volatile anesthetic.

If I decide at the end of this rotation that I may want to go into anesthesia, I'm definitely having the muscle biopsy done. If it's negative, great. If it's positive, I'm not sure what I'll decide, but I definitely don't want to be the first case report some day.