Anesthesia progress
-
Despite numerous reviews and clinical reports, much remains to be learned about the cause, treatment, and prevention of malignant hyperthermia. Among the most worrisome concerns of the clinician administering anesthesia is the malignant hyperthermia crisis. ⋯ The exact triggering mechanisms of malignant hyperthermia (MH) in humans are not known, but a crisis can be initiated by volatile general anesthetics, neuromuscular blocking agents, and amide local anesthetics. Although a history of an MH crisis is a diagnostic aid, previous uneventful exposure to anesthesia does not guarantee the safety of the patient in subsequent anesthetic procedures.(1) For these reasons, it is important for the anesthesiologist to be aware of the initial signs of MH and to be prepared to provide immediate treatment to reverse such a crisis.
-
Since the use of narcotics was initially advocated 28 years ago, serious adverse reactions, including fatalities, have been reported. At least four factors appear to contribute to these reactions: multiple drug administration, excessive dosage, inadequate monitoring, and ineffectual emergency care. Because of the relatively high incidence of life-threatening reactions and the complexity of the required emergency care, the routine use of pediatric sedation techniques that require large doses of narcotics cannot be advocated for use in the private office.