In this situation the initial need is to clarify whether the patient is at risk of MH or not.  This can be done by taking as detailed a family history as possible and then contacting the Leeds MH Unit.   The minimum information that the MH Unit will require is the name and date of birth of a family member who has been diagnosed with MH and their relationship to the current patient.  Previous tests on family members may provide reassurance that the current patient could not have inherited the MH risk.  If this is not the case then the MH Unit will be able to advise on what testing would be required and the timescale for this.  With this information the consultant anaesthetist will be able to discuss with the patient’s surgeon the pros and cons of delaying surgery until the patient’s MH status can be clarified or proceeding with surgery and treating the patient as susceptible to MH.

The patient with an anaesthetic history possibly implicating MH

A patient reporting problems with previous anaesthetics should always be questioned to find out as much detail about the problem as possible.  We still encounter a few patients who have been told by  the anaesthetist who  was looking after them during the problem anaesthetic that they could have had an MH reaction but who subsequently did not refer them for follow-up.  A more common scenario is that the patient has some information about what happened to them but  not what led to the problem.

Events known to be associated with MH include:

• muscle rigidity
• cardiac arrest
• unplanned admission to intensive care
• postoperative rhabdomyolysis (muscle breakdown)
• high temperature during or immediately after an anaesthetic

Events not suggestive of MH include:

• High blood pressure
• A skin rash (although flushing or mottling of the skin can occur with MH)
• Delayed recovery from Anastasia
• High temperature developing after discharge from the post Anastasia care unit

If you think a patient’s  anaesthetic history is  compatible with a possible MH reaction,  please seek advice from the Leeds MH unit.