According to a report by an expert panel published in the January issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS), ambulatory surgical centers (ASCs) need to develop policies for managing malignant hyperthermia, a rare yet serious reaction to anesthetics as numbers of surgical procedures performed outside hospitals are on the increase.

Lead author Dr. Marilyn Green Larach of Penn State College of Medicine in Hershey, Pa., and her fellow experts have included a guide in their report that ASCs can follow to develop plans for the transferals of patients with malignant hyperthermia (MH) to nearby hospitals for advanced care.

Once MH, a rare condition in which people who are genetically susceptible to certain anesthetics and other drugs rapidly develop high body temperature and muscle rigidity is recognized, clinicians can avoid the reaction by substituting other anesthetics. Doctors are usually unaware which patients are susceptible to the reaction until the patient or a family member experiences an episode of MH.

When a patient develops MH, he or she needs to be immediately transferred to a hospital with critical care crisis management facilities. Over the past few years ASCs without the facilities to manage these potentially life-threatening reactions have seen a rapid increase in surgical procedures.

A panel of 13 experts who represent the Malignant Hypterthermia Association of the United States developed the guide assisted by experts in emergency medicine, anesthesia, ambulatory surgery, and nursing. They concluded that it is necessary for every ASC to design their own particular MH management plan based on individual circumstances, and that all ASCs must be prepared to intravenously administer dantrolene, a muscle relaxant emergency medication, prior to the patient’s transfer. According to research, the risk of substantial complications of MH patients doubles for every 30-minute that dantrolene treatment is delayed.

The guide contains a list of problems that can be encountered as well as potential treatments, enabling each ASC to consider developing their own individual MH transfer plan. The guide includes key issues, such as the capabilities of the transport team and transfer hospital, indicators of patient stability, making the decision to transfer, and coordinating communications.

Even though according to the estimation of one study, only 1 patient in every 300,000 surgical out-of hospital procedures is affected by MH, the amount of surgical procedures performed at ASCs are already in their millions and growing rapidly, making it inevitable that some MH incidents will occur. According to the panel’s estimations, each year almost 50 MH incidents occur in ASCs that are not attached to hospitals.

Dr. Larach and her fellow panel members anticipate their guide will assist ASCs to “achieve optimal streamlined care with particular attention to the unique medical requirements of the surgical/medical patient with an MH crisis,” and urge each ASC to develop an MH transfer plan or to review, and/or revise their existing plan. They also point out that the guide may also prove relevant to other non-hospital settings where anesthetics are used that could potentially cause MH, such as surgical or dental offices.

Written by Petra Rattue