Malignant Hyperthermia: Colleagues of a Common Cause

Ramesh M. Singa MD, MHS; Cristina G. Pamaar MD
Department of Anesthesiology and Perioperative Medicine,
Saint Barnabas Medical Center, Livingston, NJ 07039

American and Filipino forces came together in Iloilo City, Philippines, on 8 January 2016. The group of healthcare professionals from the United States was led by Saint Barnabas Medical Center (Livingston, NJ) anesthesiologist and Marian Rose World Mission non-profit organization founder Dr. Cristina G. Pamaar. At the end of a week of medical and civic services in Iloilo, the group brought forth a symposium on malignant hyperthermia (MH) to their counterparts in the Philippines that Friday. The symposium was supported by the Malignant Hyperthermia Association of the United States (MHAUS) via educational materials and guidance of MHAUS President Dr. Henry Rosenberg. Dr. Pamaar commenced the event by addressing the crowd of 100 nurses, physicians, and students, in the auditorium at Saint Paul University. She described the significance of recognizing the life-threatening syndrome of MH and how the symposium’s tutorial components which would confer knowledge to save the lives of patients.

The first lecturer was Dr. Jonathon Smith, a practicing anesthesiologist from Alabama and previous resident of Dr. Pamaar. He presented a number of topics pertaining to MH, including signs and symptoms, causes, pathophysiology, diagnosis, prevention, and treatment. The second lecturer was Dr. Ramesh M. Singa, a resident in anesthesiology at Saint Barnabas Medical Center. He presented a mock MH drill, provided by MHAUS, and brought the audience’s attention to important elements during an MH episode, including changes in vital signs, coordinated teamwork to deliver care, and techniques of rapid dantrolene reconstitution.

After the two lectures, the audience separated into smaller groups and was directed toward several MH tutorial stations. At one station, Dr. Sophonie Noel, an anesthesiology resident at Saint Barnabas Hospital, discussed a case report of MH occurring at the Saint Barnabas Ambulatory Care Center. At another station, Dr. Seema Kamisetti, a regional anesthesia fellow at Vanderbilt University, demonstrated the items of the MH tackle box donated to Iloilo medical community by the Marion Rose foundation, including dantrolene, furosemide, sodium bicarbonate, intravenous tubing, and other essentials for appropriate patient care. Three other stations comprised of interactive case scenarios with mannequins equipped with prompts that the small-group audience would choose from and the case moderator would provide the best recourse in the situation if a less effective answer was given. These stations were moderated by Dr. Pamaar; Dr. Christopher O’Mahoney, an anesthesiologist at Saint Barnabas Medical Center, Nina Weeks Bullard, a certified nurse anesthetist from Boston, and Athena Kerin, a certified nurse anesthetist; and Drs. Singa and Smith.

There was an incredible amount of enthusiasm during the entire symposium, easily recognized by the quantity and quality of questions asked by the audience. By the end of the day, smiling Pilipino faces gave hugs and took photos with their American counterparts. It was without a doubt that the diffusion of knowledge of MH throughout Iloilo and the rest of the Philippines will endure, helped by colleagues of a common cause.