malignant hyperthermia susceptible

[Pianoboe01]

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I will be starting med school this August and have a family history of malignant hyperthermia. My mother, grandmother, aunt, and some cousins have all had a positive CHCT, but I have not undergone the muscle biopsy test so there is a 50% chance I have the disorder. Any one know if it will be safe for me to be in an OR when triggering agents are being used? I assume low concentrations of the gases would be in the air.

 

[UTSouthwestern]

I will be starting med school this August and have a family history of malignant hyperthermia. My mother, grandmother, aunt, and some cousins have all had a positive CHCT, but I have not undergone the muscle biopsy test so there is a 50% chance I have the disorder. Any one know if it will be safe for me to be in an OR when triggering agents are being used? I assume low concentrations of the gases would be in the air.

I haven't seen any conclusive studies documenting quanitification of triggering agents, however, I've seen a patient develop fulminant MH as soon as the agent was introduced, well before saturation pharmacokinetics should have been achieved. You may be better off just getting the test.

 

[Pianoboe01]

Yeah, I suppose I probably should get the test. When my mom had it done over 20 years ago, they didn't use any anesthetic and she said it was the worst pain she could ever imagine -- like being in a torture chamber. I'm sure they use some kind of anesthetic now though. I still pose an interesting question if I am MH susceptible -- I wonder if they'd make me wear a gas mask when I do surgery rotation or if they'd have to just use non-triggering agents on the patients for my safety.

 

[UTSouthwestern]

There are many non-MH triggering regimens these days that are both safe and analgesic. I remember the last patient we did that had MH, we did with a propofol/sufentanil infusion and that patient woke up completely pain and nausea free. Minus a breast and with a huge flap, but otherwise completely happy.

Just out of curiosity, are you and/or your family from Wisconsin? That area has the highest number of known MH susceptible individuals.

 

[Pianoboe01]

Nope, I'm from Indiana.

 

[gaslord]

Just finished a review article on MH and anesthesia. I can email you a copy if you believe it can help you. Just PM me your email address...

 

[Pianoboe01]

That's ok. I found the answer to my question in the medical professionals' faq section at mhaus.org

Q: Are MH-susceptible individuals at risk for MH symptoms/episode if exposed to triggering agents while working in an operating room or similar environment?

A: There are no cases reported of MHS patients having problems on exposure to waste anesthetic gases while working in the OR. The usual OR procedures maintain low, trace amounts of the potent volatile anesthetics in the air. During a mask induction, someone within two feet or so of the face of the patient may be exposed to somewhat greater concentrations, but that is easily avoided. Further, the volatile agents are heavier than air and drift down to the floor, where the excellent ventilation systems efficiently clear the vapors. In addition, the data from pigs indicate that very low concentrations of anesthetics do not trigger MH in these highly susceptible animals. There is only one report of muscle cramps and fatigue in a person who worked in a factory where he was exposed to chemicals whose structure is similar to that of potent inhalation agents.

 

[leaverus]

I realize this is a very old thread but it makes me curious whether there are any anesthesiologists (or crnas) with known MH. Anyone know any?

 

[Mman]

I realize this is a very old thread but it makes me curious whether there are any anesthesiologists (or crnas) with known MH. Anyone know any?

considering we often get a significant exposure during inhalation inductions I think probably not. If they didn't know it, maybe dropping dead in the OR during a peds induction got the point across.

 

[Planktonmd]

Statistically there has to be some anesthesia personnel out there who are susceptible but don't know it, and the fact that we never heard of an anesthesia or OR personnel develop the crisis makes you wonder if other factors are involved.
I mean maybe the exposure to a triggering agent is just one part of the triggering process, maybe surgical stress or sympathetic response to intubation are also part of the deal.

 

[sigrhoillusion]

Statistically there has to be some anesthesia personnel out there who are susceptible but don't know it, and the fact that we never heard of an anesthesia or OR personnel develop the crisis makes you wonder if other factors are involved.
I mean maybe the exposure to a triggering agent is just one part of the triggering process, maybe surgical stress or sympathetic response to intubation are also part of the deal.

Definitely multifactorial, and sometimes it takes 2 or more exposures to have a reaction. Doubt it has to do with surgery or intubation since there are reports of MH without intubation and probably some without surgical stimulation (i.e. MRI)

 

[twoliter]

Definitely multifactorial, and sometimes it takes 2 or more exposures to have a reaction. Doubt it has to do with surgery or intubation since there are reports of MH without intubation and probably some without surgical stimulation (i.e. MRI)

Well, there is the idea of stress-induced MH. Very rare, but thought to be real.

 

[Consigliere]

Well, there is the idea of stress-induced MH. Very rare, but thought to be real.

Just like a competent CRNA.