Regular updates by our President, MHAUS staff, and guest contributors.
In this month’s blog, I have asked Dr. Stanley Caroff, Professor of Psychiatry at the University of Pennsylvania, a long time member of MHAUS and prolific author on the subject of Neuroleptic Malignant Syndrome (NMS) to summarize several drug related reactions that resemble MH in some ways but are generally thought to be unrelated to the mechanisms that lead to MH.
When an MH susceptible patient requires a general anesthetic one concern is whether he/she will be inadvertently exposed to potent gas anesthetics such as sevoflurane or isoflurane that may trigger an MH episode.
I was privileged to attend the 30th Annual European MH Group (EMHG) meeting in the town of Nijmegen, Holland from June 8-10 this year. The EMHG was developed in the early 1980s by a group of clinical anesthesiologists and researchers interested in advancing the understanding of MH and providing optimum care to MH susceptibles and their families. The EMHG has focused on testing for MH susceptibility, muscle biopsy contracture tests as well as genetic tests and their relation to biochemical and physiologic changes that underlie the MH syndrome.
On May 14, 2011 MHAUS sponsored the first ever day long retreat for our hotline and professional advisory consultants. 30 consultants, including one board member (Debra Merritt), a genetic counselor associated with the University of Pittsburgh MH DNA testing center (Deanna Steele) and Dr. Albert Urwyler, head of the MH testing center in Basel, Switzerland and member of the European MH group, met in a hotel near the Chicago O’Hare airport to discuss many perplexing issues related to MH.
As part of my “day job” I am in charge of graduate medical education (i.e. residency programs) as well as medical student education at a large academic medical center. In that capacity I and my colleagues who are supervising educational programs are required to keep up with the evolving standards that govern the training of the physicians of the future.
Last month I discussed the difficulty of understanding how MH susceptibility relates to heat stroke, muscle breakdown with exercise and MH without anesthesia. This is an exceedingly complex and murky topic.
On behalf of MHAUS, its Board, Staff, Professional Advisory Council, and Hotline Consultants I would like to wish all of you a Happy and Healthy New Year. Our hope for the future is to fulfill the mission of eliminating death and disability related to MH and MH-related syndromes.
Earlier this year I described what lies ahead for MHAUS. I laid out an ambitious program for the year. I am pleased to report that with one or two exceptions the goals were largely met. Here are some of the programs and accomplishments of 2010:
First, I would like to apologize for the somewhat technical blog I posted for October, 2010. I realize that not everyone would be familiar enough with the science of MH and cellular physiology to understand some of the information behind my reasoning. However, in basic terms what I was trying to do was separate MH into subcategories based on what is known of the molecular biology and biochemistry of the disorder. I realize too that not everyone would agree with my reasoning, but that is what a blog is for, i.e., theorizing and proposing some new ways of looking at things.
Malignant Hyperthermia (MH) is a life threatening syndrome characterized by hypermetabolism, hyperthermia, acidosis, muscle contraction, muscle membrane breakdown, hyperkalemia and rhabdomyolysis. The syndrome occurs as a result of exposure to certain drugs and /or environmental conditions.
On September 20, 2010 I had the privilege of being a visiting professor at the University of Colorado, Denver Medical School and delivering the annual Hermann B. Stein MD, endowed lecture. Dr. Stein practiced anesthesiology in Denver for many years in the 1920s, 30s and 40s. His son then became an anesthesiologist and practiced the specialty for close to 40 years. One of his daughters is now a practicing anesthesiologist in New England. Three generations of anesthesiologists. Pretty striking.
Over the past several months, since our April scientific conference, I have been thinking about the question “How should we define MH”? Sounds like a pretty straightforward question, but in reality it is quite complex.
July 2010 will mark the 50th anniversary of a publication that identified an inherited condition that would eventually be named Malignant Hyperthermia Syndrome.
In March of 2010 we carried out an MH drill at my institution. It was an important exercise and we learned several important lessons.
Over the past many years since MH was first described, a lot has been learned about both the clinical presentations as well as the underlying problems that cause malignant hyperthermia. Of course there is much more to learn but often as new information is accumulated those ideas or clinical recommendations that were based on concepts that have been disproved remain. In this blog I will describe ten myths related to MH that hotline consultants still hear either from callers or at national meetings
Thanks to the efforts of many patients and health care providers who have an interest in the problem of MH, many states will declare March to be MH Awareness and Training month. This effort will serve to alert the community of patients and providers to the problem of MH and prevent deaths and disability from MH.
As we begin the New Year and the new decade, it is appropriate to review the accomplishments of the past year and look forward to what lies ahead for the next year(s).
Advances in anesthesia care over the past several decades have changed the way anesthetics are administered. Compared to even three decades ago anesthesiology has changed from an art to a science (although still a somewhat inexact science). One of the crucial developments in anesthesiology that is responsible for the improved outcomes in anesthesia care is the exact measurement of physiologic changes.
Each October thousands of anesthesiologists gather together for five days under the auspices of the American Society of Anesthesiologists for an annual comprehensive meeting on issues related to anesthesiology. The meeting consists of scientific presentations, commercial exhibits, and discussions of political and organizational issues related to the specialty.
In early May 2006 I received a phone call from the Medical Examiner’s office in New York City. The reason for the call was a death of a young man a day or so previously in after surgery in an ambulatory surgery center on the upper East Side of Manhattan.