ANESTHESIA FOR CESAREAN DELIVERY OF A MALIGNANT HYPERTHERMIA SUSCEPTIBLE PARTURIENT

The anaesthetic management for Caesarean delivery of a parturient with a strong family history of malignant hyperthermia (MH) is presented. Before surgery an anaesthetic machine that was in regular use was prepared by replacing all rubber or disposable components and flushing with O-2 at 10 L.min(-1) for one hour. Dantrolene prophylaxis was not used, and the patient received a bupivacaine and fentanyl spinal anaesthestic. Hypotension was treated with ephedrine. Current management of the MH patient no longer mandates a dedicated vapour-free machine, dantrolene is not indicated as pre-treatment, and amide local anaesthetics are considered safe. The role of vasopressors and ergot preparations is less clear.