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May/Jun 2014

Ambulatory Facial Plastic Surgery Centers and Malignant Hyperthermia

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
  • 2Department of Plastic Surgery, Rockwood Clinic, Spokane, Washington
  • 3Farrior Facial Plastic and Cosmetic Surgery Center, Tampa, Florida
JAMA Facial Plast Surg. 2014;16(3):167-168. doi:10.1001/jamafacial.2013.2506

The number of ambulatory surgery centers continues to increase, and they are increasingly used by facial plastic surgeons. With their increasing use, it is essential that surgeons are aware of malignant hyperthermia (MH) in order to perform surgery safely.

Malignant hyperthermia was first described in 1960 by Denborough and Lovell.1 It is an autosomal-dominant disorder linked to ryanodine receptor type 1 gene (RYR1) (OMIM 180901) mutations. This mutation results in abnormal calcium metabolism triggered by a sensitivity to volatile anesthetics and depolarizing neuromuscular blocking drugs, resulting in skeletal muscle hypermetabolism.2 Malignant hyperthermia is a rare but life-threatening occurrence in approximately 1 in 100 000 anesthetic procedures.3 Now estimated to be approximately 6.5%, mortality rates have declined since the 1970s secondary to the implementation of dantrolene sodium therapy and increased awareness.3

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