From thePalm Beach Postcomes the tragic death of Florida teen, StephanieKuleba, from a rare allergic reaction to inhalation anesthetics calledmalignanthyperthermia(MH).Wikipediadescribes it succinctly as a idiosyncratic reaction that "induces a drastic and uncontrolled increase in skeletal muscleoxidativemetabolism which overwhelms the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if untreated."
There's really no way to screen for this process and a patient can die quickly. Most surgeons and anesthesiologists may go their entire career and never see a true case of it. I was talking to one of my colleagues the other day about office based surgery and he said he was unlikely to return to doing that after seen a near fatalMHon a cosmetic surgery case he was doing in an ambulatory surgery center adjacent to a hospital.
I'm not sure what the take home message from this is. It's such a rare event that it's hard to justify having exoticprotocolsat all times in low risk procedures. Most office surgery suites maintain a supply ofDantrolene, a medicine to treatMHwhich is almost $2500 per dose and must be restocked often to stay current. There's plenty of adverse events more common thenMH, but we don't have aorticballoonpumps or cardiac bypass machines routinely laying around for that. It already sounds like that the family has hired an attorney who is already assuming an aggressive posture in his comments to the media so I'm sure we'll see some legalproceedingseven ifperfect care forMHwas instituted.