18 year old girl dies during breast augmentation in Florida
The headline says it all. Any unforeseen, untimely death is a true tragedy. This is particularly true in a healthy person undergoing an elective procedure. This blog entry is not to place or relinquish blame on any party, only to educate the public on the facts of the case and how to help avoid such a disaster.
FACT:
1. The operating surgeon was a BOARD CERTIFIED PLASTIC SURGEON
2. An anesthesiologist was performing the anesthesia
3. It was performed in an accredited ambulatory surgery center
Early reports of this incident point to a diagnosis of MALIGNANT HYPERTHERMIA as what caused this terrible event.
What is malignant hyperthermia (MH)?
MH is a hypermetabolic state involving skeletal muscles that is triggered by certain anesthetic drugs in genetically susceptible individuals. Its incidence is less than 0.5% of all patients exposed to anesthetic agents.
Which patients are at risk of developing MH?
1. Someone with a first degree relative with a diagnosis of MH (it is autosomal dominant inherited)
2. An elevated resting blood creatine kinase level and family with suspected MH tendency
3. central core disease
4. musculoskeletal disease associated with MH
a. dystrophinopathy
b. phosphorylase deficiency
c. minicore disease
d. myotonia
e. King-Denborough and Barnes myopathies
Patients who are susceptible to MH can have a muscle contracture test performed prior to surgery. A muscle biopsy is another alternative for diagnosis.
There are a number of drugs that can trigger MH. Most of these drugs are drugs used to induce and maintain GENERAL ANESTHESIA. This is another reason I choose deep sedation whenever possible to perform surgery to avoid these drugs. The patients still have no recall of the surgery, are comfortable, but are breathing on their own without the need for a mechanical ventilator, breathing tube, or being paralyzed for the surgery.
These drugs are:
INHALATION ANESTHESTICS:
Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane
DEPOLARIZING NEURMUSCULAR BLOCKADE AGENTS:
Succinylcholine, Decamethonium, Suxamethonium
OTHERS:
Ketamine, Catecholamines, Phenothiazines, Monoamine oxidase inhibitors
How does the doctor know if MH is occurring during the surgery?
An unexplained rise in CO2, or heart rate following induction of anesthesia are important signs. Additionally, early masseter contracture following the administration of succinylcholine can be a clue.
How is this treated if MH is diagnosed during the surgery?
There is a comprehensive treatment algorithm for treating MH including the administration of dantrolene sodium. If administered and the correct protocol is followed the survival rate is 100%. If dantrolene is not administered the survival rate is less than 60%.
How can MH be prevented?
Patients at an increased risk for MH should be recognized in the preoperative phase of treatment planning. These patients should not be given these triggering agents.
From what I have read about this particular recent case, it sounds like this young lady did have an episode of malignant hyperthermia. Unfortunately, it appears that her being identified as a high risk of developing this, was not established prior to the case. In addition, it seems like the correct treatment protocol was put in place, but too late. She was transported to another facility before the dantrolene sodium dosing was started.
If a fear of developing malignant hyperthermia is a concern for you in preparing to undergo cosmetic surgery-good. It is a concern for us too.
What should ease your mind is at CAMEO Surgery:
1. those at risk of developing this are easily identifiable (is has been on our medical history questionnaire since day 1)
2. we are fully prepared to treat any incidence of this during surgery, by myself and our board certified anesthesiologist
3. we avoid these triggering drugs by avoiding general anesthesia, and instead use deep sedation (a safe and comfortable alternative for your cosmetic surgery)
For those of you with more questions, please contact us. Additoinally, there is a hotline available 24/7 to help in the management of MH in the US; the number is (800) MH-HYPER. Outside the US call (800) 644-9737. Their website is http://www.mhaus.org
FACT:
1. The operating surgeon was a BOARD CERTIFIED PLASTIC SURGEON
2. An anesthesiologist was performing the anesthesia
3. It was performed in an accredited ambulatory surgery center
Early reports of this incident point to a diagnosis of MALIGNANT HYPERTHERMIA as what caused this terrible event.
What is malignant hyperthermia (MH)?
MH is a hypermetabolic state involving skeletal muscles that is triggered by certain anesthetic drugs in genetically susceptible individuals. Its incidence is less than 0.5% of all patients exposed to anesthetic agents.
Which patients are at risk of developing MH?
1. Someone with a first degree relative with a diagnosis of MH (it is autosomal dominant inherited)
2. An elevated resting blood creatine kinase level and family with suspected MH tendency
3. central core disease
4. musculoskeletal disease associated with MH
a. dystrophinopathy
b. phosphorylase deficiency
c. minicore disease
d. myotonia
e. King-Denborough and Barnes myopathies
Patients who are susceptible to MH can have a muscle contracture test performed prior to surgery. A muscle biopsy is another alternative for diagnosis.
There are a number of drugs that can trigger MH. Most of these drugs are drugs used to induce and maintain GENERAL ANESTHESIA. This is another reason I choose deep sedation whenever possible to perform surgery to avoid these drugs. The patients still have no recall of the surgery, are comfortable, but are breathing on their own without the need for a mechanical ventilator, breathing tube, or being paralyzed for the surgery.
These drugs are:
INHALATION ANESTHESTICS:
Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane
DEPOLARIZING NEURMUSCULAR BLOCKADE AGENTS:
Succinylcholine, Decamethonium, Suxamethonium
OTHERS:
Ketamine, Catecholamines, Phenothiazines, Monoamine oxidase inhibitors
How does the doctor know if MH is occurring during the surgery?
An unexplained rise in CO2, or heart rate following induction of anesthesia are important signs. Additionally, early masseter contracture following the administration of succinylcholine can be a clue.
How is this treated if MH is diagnosed during the surgery?
There is a comprehensive treatment algorithm for treating MH including the administration of dantrolene sodium. If administered and the correct protocol is followed the survival rate is 100%. If dantrolene is not administered the survival rate is less than 60%.
How can MH be prevented?
Patients at an increased risk for MH should be recognized in the preoperative phase of treatment planning. These patients should not be given these triggering agents.
From what I have read about this particular recent case, it sounds like this young lady did have an episode of malignant hyperthermia. Unfortunately, it appears that her being identified as a high risk of developing this, was not established prior to the case. In addition, it seems like the correct treatment protocol was put in place, but too late. She was transported to another facility before the dantrolene sodium dosing was started.
If a fear of developing malignant hyperthermia is a concern for you in preparing to undergo cosmetic surgery-good. It is a concern for us too.
What should ease your mind is at CAMEO Surgery:
1. those at risk of developing this are easily identifiable (is has been on our medical history questionnaire since day 1)
2. we are fully prepared to treat any incidence of this during surgery, by myself and our board certified anesthesiologist
3. we avoid these triggering drugs by avoiding general anesthesia, and instead use deep sedation (a safe and comfortable alternative for your cosmetic surgery)
For those of you with more questions, please contact us. Additoinally, there is a hotline available 24/7 to help in the management of MH in the US; the number is (800) MH-HYPER. Outside the US call (800) 644-9737. Their website is http://www.mhaus.org
posted by Dr. Scott M Blyer at
7:26 AM
0 Comments:
Post a Comment
Subscribe to Post Comments [Atom]
<< Home