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LETTERS TO THE EDITOR

Muscle Biopsy for Malignant Hyperthermia Testing Can Be Scheduled and Performed in 6 Weeks

Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA

To the Editor:

I read with interest the article by Rosen et al (1). They describe the successful anesthetic management of a woman undergoing fetal surgery for treatment of congenital diaphragmatic hernia. Her paternal great-uncle probably had a malignant hyperthermia (MH) episode; she and her infant were therefore treated as MH susceptible. Because potent anesthetic gases were contraindicated, the authors administered large-dose (16 µg/kg/min) IV nitroglycerin to provide surgical tocolysis during cesarean delivery and ex utero intrapartum treatment (EXIT) procedure. Rosen states that MH susceptibility testing of the patient or her father could not be performed in time for surgery.

While I agree that testing could not be performed in time for the first procedure, I am puzzled that there was no attempt to have the patient’s father tested during the 6 weeks that elapsed between fetal tracheal occlusion and cesarean delivery and fetal EXIT procedure. There are MH diagnostic centers at both the University of California at Davis and the University of California at Los Angeles. It is possible to schedule and perform muscle biopsy for contracture testing within this time frame. As noted by the authors, if her father had a negativein vitro contracture test, the patient and her fetus could have been treated without changing to MH trigger-free techniques. Contact information for U.S. testing centers is available at the Web site for the Malignant Hyperthermia Association of the United States—MHAUS (www.mhaus.org).

Reference

1. Rosen MA, Andreae MH, Cameron AG. Nitroglycerin for fetal surgery: fetoscopy and ex utero intrapartum treatment procedure with malignant hyperthermia precautions. Anesth Analg 2003; 96: 698–700.[Abstract/Free Full Text]

Response

University of California San Francisco, San Francisco, CA

In Response:

Dr. Rosenbaum states that he is "puzzled that there was no attempt to have the patient’s father tested during the 6 weeks that elapsed between fetal tracheal occlusion and cesarean delivery and fetal EXIT procedure," as described in our recent case report. (1) Dr. Rosenbaum presumes that no effort was made. In fact, the clinicians caring for this patient were well aware of the relatively nearby diagnostic centers at both the University of California at Davis and the University of California at Los Angeles, however the patient was estranged from her father and attempts to locate him were unsuccessful.

Reference

1. Rosen MA, Andreae MH, Cameron AG. Nitroglycerin for fetal surgery: fetoscopy and ex utero intrapartum treatment procedure with malignant hyperthermia precautions. Anesth Analg 2003; 96: 698–700.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rosenbaum, H. K. Articles by Rosen, M. A. Search for Related Content PubMed PubMed Citation Articles by Rosenbaum, H. K. Articles by Rosen, M. A.