With the emphasis on cost reduction, more surgery is being performed in offices and outpatient centers. At least 400 MH cases occur in the US each year and at least 2-3 young healthy patients die. Testing for MH is available by a special muscle biopsy test that is performed in nine centers in the U.S., including Thomas Jefferson University. Further investigation showed that these children had muscular dystrophy, but were as yet asymptomatic. In this case, death was due to elevated potassium incident to the administration of the paralyzing agent succinylcholine.
Elevated potassium stops the heart.
This led to a change in the package insert for this drug advising against the routine use of succinylcholine in children. What is not generally appreciated is that this phenomenon may happen weeks after major trauma if the patient is immobilized for several weeks. Local anesthetics were first discovered about 100 years ago. Local anesthetics are used commonly by anesthesiologists as well as non-anesthesiologists. If the local anesthetic is injected into a vessel in large amounts, the patient may experience a seizure and cardiac arrest.