Abstract
The anaesthetic management for Caesarean delivery of a parturient with a strong family history of malignant hyperthermia (MH) is presented. Before surgery an anaesthetic machine that was in regular use was prepared by replacing all rubber or disposable components and flushing with O2 at 10 L · min−1 for one hour. Dantrolene prophylaxis was not used, and the patient received a bupivacaine and fentanyl spinal anaestheslic. Hypotension was treated with ephedrine. Current management of the MH patient no longer mandates a dedicated vapourfree machine, dantrolene is not indicated as pre-treatment, and amide local anaesthetics are considered safe. The role of vasopressors and ergot preparations is less clear.
Résumé
Cette observation décrit la prise en charge d’une parturiente présentant des antécédents concluants d’hyperthermia maligne (HM) programmée pour une extraction foetale par césarienne. Avant l’intervention, toutes les tubulures en caoutchouc et les composantes jetables d’un appareil d’anesthésie régulièrement utilisé sont remplacées et on y fait circuler de l’oxygène au débit de 10 L · min−1 pendant une heure. La patiente n’est pas préparée avec du dantrolène. Elle reçoit une rachianesthésie à la bupivacaïne et au fentanyl. L’hypotension est contrôlée avec de l’éphédrine. La technique de prise en charge actuelle de l’HM ne prévoit plus l’utilisation d’un appareil d’anesthésie exclusif exempt de vapeurs d’agents inhalatoires, le dantrolène sodium n’est plus prescrit en pré-traitement et les anesthésiques locaux de type amide ne sont pas contre-indiqués. Le rôle des vasopresseurs et des dérivés de l’ergot est moins clair.
Article PDF
Avoid common mistakes on your manuscript.
References
Liebenschütz F, Mai C, Pickerodt VWA. Increased carbon dioxide production in two patients with malignant hyperpyrexia and its control by dantrolene. Br J Anaesth 1979; 51: 899–903.
Lips FJ, Newland M, Dutton G. Malignant hyperthermia triggered by cyclopropane during cesarean section. Anesthesiology 1982; 56: 144–6.
Cupryn JP, Kennedy A, Byrick RJ. Malignant hyperthermia in pregnancy. Am J Obstet Gynecol 1984; 150: 327–8.
Wadhwa RK. Obstetric anesthesia for a patient with malignant hyperthermia susceptibility. Anesthesiology 1977; 46: 63–4.
Willatts SM. Malignant hyperthermia susceptibility. Management during pregnancy and labour. Anaesthesia 1979; 34: 41–6.
Khalil SN, Williams JP, Bourke DL. Management of a malignant hyperthermia susceptible patient in labor with 2chloroprocaine epidural anesthesia. Anesth Analg 1983; 62: 119–21.
Douglas MJ, McMorland GH. The anaesthetic management of the malignant hyperthermia susceptible parturient. Can Anaesth Soc J 1986; 33: 371–8.
Gronert GA. Malignant hyperthermia. Anesthesiology 1980; 53: 395–423.
Isherwood DM, Ridley J, Wilson J. Creatinine phosphokinase (CPK) levels in pregnancy: a case report and a discussion of the value of CPK levels in the prediction of possible malignant hyperpyrexia. Br J Obstet Gynaecol 1975; 82: 346–9.
Britt BA. Malignant hyperthermia. Can Anaesth Soc J 1985; 32: 666–77.
Sorosky JI, Ingardia CJ, Botti JJ. Diagnosis and management of susceptibility to malignant hyperthermia in pregnancy. Am J Perinatol 1989; 6: 46–8.
Nagarajan K, Fishbein WN, Muldoon SM, Pezeshkpour G. Calcium uptake in frozen muscle biopsy sections compared with other predictors of malignant hyperthermia susceptibility. Anesthesiology 1987; 66: 680–5.
Britt BA. Dantrolene. Can Anaesth Soc J 1984; 31: 61–75.
Morison DH. Placental transfer of dantrolene (Letter). Anesthesiology 1983; 59: 265.
Weingarten AE, Korsh JI, Neuman GG, Stern SB. Postpartum uterine atony after intravenous dantrolene. Anesth Analg 1987; 66: 269–70.
Longmire S, Lee W, Pivarnik J. Malignant hyperthermia.In: Datta S (Ed.). Anesthetic and Obstetric Management of High-Risk Pregnancy. St. Louis: Mosby Year Book, 1991; 330–44.
McGraw TT, Keon TP. Malignant hyperthermia and the clean machine. Can J Anaesth 1989; 36: 530–2.
Beebe JJ, Sessler DI. Preparation of anesthesia machines for patients susceptible to malignant hyperthermia. Anesthesiology 1988; 69: 395–400.
Updated technical bulletin for malignant hyperthermia. American Society of Anesthesiologists Newsletter 1992; 56: 30–1.
Gronert GA, Thompson RL, Onofrio BM. Human malignant hyperthermia: awake episodes and correction by dantrolene. Anesth Analg 1980; 59: 377–8.
Shnider SM, Levinson G. Anesthesia for cesarean section.In: Shnider SM, Levinson G (Eds.). Anesthesia for Obstetrics, 3rd ed., Baltimore: Williams & Wilkins, 1993; 211–46.
Lucy SJ, Naugler MAK. Spinal anaesthesia for Caesarean section (Letter). Can J Anaesth 1991; 38: 940–1.
Gronert GA, Mott J, Lee J. Aetiology of malignant hyperthermia. Br J Anaesth 1988; 60: 253–67.
Paasuke RT, Brownell AKW. Amide local anaesthetics and malignant hyperthermia (Editorial). Can Anaesth Soc J 1986; 33: 126–9.
MHAUS Professional Advisory Council adopts new policy statement on local anesthetics. MHAUS Communicator, Vol III, No 4, Spring, 1985.
Baysinger CL, Cummins DT, Kearney BP, Daniels DE, Menk EJ. Intrathecal bupivacaine and tetracaine for cesarean section. Anesthesiology 1989; 71: A865.
Hall GM, Lucke JN, Lister D. Porcine malignant hyperthermia. V: Fatal hyperthermia in the Pietrain pig, associated with the infusion of α-adrenergic agonists. Br J Anaesth 1977; 49: 855–63.
Urwyler A, Censier K, Seeberger MD, Rothenbühler JM, Kaufman MA, Drewe J.In vitro effect of ephedrine, adrenaline, noradrenaline and isoprenaline on halothaneinduced contractures in skeletal muscle from patients potentially susceptible to malignant hyperthermia. Br J Anaesth 1993; 70: 76–9.
Sewall K, Flowerdew RMM, Bromberger P. Severe muscle rigidity at birth: malignant hyperthermia syndrome? Can Anaesth Soc J 1980; 27: 279–82.
Hinkle AJ, Dorsh JA. Maternal masseter muscle rigidity and neonatal fasciculations after induction for emergency cesarean section. Anesthesiology 1993; 79: 175–7.
Strazis KP, Fox AW. Malignant hyperthermia: a review of published cases. Anesth Analg 1993; 77: 297–304.
Crawford JS. Hyperpyrexia during pregnancy (Letter). Lancet 1972; 1: 1244.
Fusi L, Maresh MJA, Steer PJ, Beard RW. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet 1989; 1: 1250–2.
Camann WR, Hortvet LA, Hughes N, Bader AM, Datta S. Maternal temperature regulation during extradural analgesia for labour. Br J Anaesth 1991; 67: 565–8.
Larach MG, Localio AR, Allen GC, et al. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology 1994; 80: 771–9.
Lennon RL, Olson RA, Gronert GA. Atracurium or vecuronium for rapid sequence endotracheal intubation. Anesthesiology 1986; 64: 510–3.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lucy, S.J. Anaesthesia for Caesarean delivery of a malignant hyperthermia susceptible parturient. Can J Anaesth 41, 1220–1226 (1994). https://doi.org/10.1007/BF03020666
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03020666