Anaesthetic management of the malignant hyperthermia susceptible parturient.

An overall management plan for malignant hyperthermia susceptible (MHS) parturients is presented based on the experience of managing 14 of these patients. A summary of the pertinent features of their deliveries and care plus a case report of one of these parturients is described. Discussion centres around the problems of diagnosis of malignant hyperthermia susceptibility in pregnancy, the differential diagnosis and management of fever and tachycardia in a MHS parturient during labour and the use of dantrolene prophylaxis. Management of the MHS parturient in labour includes temperature and heart-rate monitoring, provision for cooling, and ready availability of a vapour-free anaesthetic machine. A large-bore intravenous infusion for hydration and for potential therapy of a MH crisis is essential. Epidural analgesia, using 2-chloroprocaine, is recommended. Emergency and elective Caesarean section anaesthesia are discussed. The importance of being prepared for a potential crisis is stressed with particular emphasis on early diagnosis by monitoring of temperature at two sites, of heart rate and rhythm with a continuous ECG and of end-tidal carbon dioxide, should a general anaesthetic be required. Recommendations are made for appropriate anaesthetic agents for both regional and general anaesthesia. Treatment of a MH crisis is outlined, with emphasis on availability of appropriate resuscitative drugs.