Post-MH Event Plan and Counseling

1. Document possible MH event in institutional chart. Add inhalational anesthetics (sevoflurane, desflurane, isoflurane) and succinylcholine to patient’s adverse drug reactions.
2. Consult with MHAUS Hotline Consultant to determine if further testing is required to establish a diagnosis of MH susceptibility. (MHAUS Hotline 1-800-644-9737; outside the US, please call: 001-209-417-3722)
   • MH clinical grading scale (Anesthesiology 1994)
   • MH diagnostic muscle assay, the caffeine halothane contracture test (CHCT). Surgery for biopsy and CHCT must be done at an MH biopsy center. (Locations and Contacts)
   • MH molecular genetic testing (More Information)
3.   Report acute MH event to the North American Malignant Hyperthermia Registry of MHAUS. (AMRA Report) Ask the patient to contact the Registry to sign consent if he/she wishes to link reported information with his/her name. (NAMHR Contacts)
4. Obtain information about any prior personal or family history of anesthetic difficulties. Oftentimes, after an event, family members have additional recall of similar events in the family.
5. Obtain information about any unusual responses to exercise or heat-stress including unexplained fevers, dark-colored urine, and/or severe muscle cramps.
6. If positive, patient may need to be counseled to avoid exposure to severe exercise and heat stress and consider prescription of oral dantrolene. Discuss with MHAUS Hotline Consultant. (MHAUS Hotline 1-800-644-9737; outside the US, please call: 001-209-417-3722)
7. Arrange for follow-up creatine kinase testing with primary care physician if still elevated at the time of discharge. Consider neurology referral.
8. Refer the patient and family to MHAUS for further information. (Patient Liaison Committee)
   • Sample letters to notify relatives of MH susceptibility
   • Medical identification bracelets/necklaces through Medic-Alert*
   • Emphasize importance of notifying health care providers in advance of elective procedures. (Sample letter)

 * Suggested text for Medic-Alert* bracelet:

Malignant
Hyperthermia
No Volatile Anesthetics/No Succinylcholine
MHAUS
800-644-9737