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The Risk and Management of Malignant Hyperthermia in Plastic Surgery

The news today of a teenager who has died in Florida while undergoing breast surgery due to malignant hyperthermia is a horrible tragedy. Many will ask could it have been prevented and how can this happen today with all the technology available in modern medicine? Most of the pubic is unaware of this very rare, but very dangerous genetic condition, known as malignant hyperthermia. Its onset will usually only ever happen when presenting for surgery and undergoing anesthesia, either in an operating room, office, or even an emergency room setting. I have witnessed two patients in my academic career who developed this condition during the onset of anesthesia for surgery and it is dramatic and lethal if not immediately and aggressively treated. Every accredited operating room facility today is required to have an emergency malignant hyperthermia response kit which includes the drug Dantrolene.
Malignant hyperthermia is a bizarre biochemical reaction of the muscles to certain anesthetic agents. These agents include many of the gases (not nitrous oxide) that keep you asleep and to certain of the muscle relaxants which the anesthesiologist uses to temporarily paralyze you to pass a breathing tube. Immediately, the muscles freeze up and body temperature skyrockets, robbing the brain and other vital organs from the necessary oxygen that they need and releasing large amounts of potassium which can stop the heart. This reaction is immediate and without any warning. Even with the best of medical care, death can occur and, even if the patient lives, they may be left with organ damage. Fortunately, the drug Dantrolene has been known to effectively treat malignant hyperthermia for over 20 years and is now widely stocked in most operating rooms that I have been in. This drug, as well as methods to cool the patient, have been life-saving in many cases.
Unfortunately, there is no simple test before surgery to know if one is susceptible to malignant hyperthermia. Nor is it part of any routinue screening due to its rarity. The best indicator is suspicion, a family history that someone has had ‘problems’ with anesthesia in the past. Then a muscle biopsy can be done to confirm its presence

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Anesthesia and plastic surgery can still be done in someone with or suspected of malignant hyperthermia. Local anesthetics, nitrous oxide gas, narcotics, and sedative drugs such as Valium, Versed and PropofolĀ are not known to trigger malignant hyperthermia can be used exclusively over those anesthetic agents known to trigger it.

Dr Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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