Nose and chin .. Liposuction under chin and bump removed on nose
I Have Malignant Hypothermia but Really Want Plastic Surgery, is There Anywhere That Offers This?
Doctor Answers 10
Malignant Hyperthermia and Elective Surgery
There are certain drugs that cause MH, specifically inhalational anesthetics (the sleeping gasses), and depolorizing muscle relaxants. Some gasses are much less likely than others to trigger it, but if you have the MH gene, you should just avoid all of them.
It is very possible to do the surgery you want avoiding all triggering agents. In fact I do all of my surgery avoiding these trigger agents. IV anesthesia with a combination of drugs including propofol, ketamine, versed, and fentanyl is my standard technique. You should avoid being intubated (breathing tube in the lungs) and connected to a machine since any traces of gas in the machine from other users might still be present. If you are connected to a machine, it needs to be a specially set aside machine that is only used on MH patients and has never had any triggering agents loaded into it.
Using the drug combination I mentioned renders patients completely asleep for the surgery, but they continue to breath under their own power without a tube.
Also consider doing the procedure with just oral pills to relax you and local anesthesia. The neck can certainly be done this way, the nose requires a person with a little bit more courage.
Malignant Hypothermia and Rhinoplasty
I really don’t think it is prudent, if you have a documented history of malignant hypothermia, to undergo any type of elective surgery as this has a high mortality rate.
Nose and chin with MH
The chin liposuction and a small bump on the nose could potentially be performed under local anesthesia with a little valium. A full rhinoplasty would require general anesthesia, but someone with MH would have to be done in a hospital setting with all of the necessary precautions mentioned previously, which will only increase the costs.
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Plastic Surgery in the Malignant Hyperthermia Patient
With a known history of maliognant hyperthermia (MH), all necessry precautions can be done to have an uneventful surgical experience. The key is the anesthesiologist who should have experience in the past of dealing with the MH patient and avoiding all known triggers and has Dantrolene available should it be necessary.
essentially you can most likely still have surgery but it is up to your surgeon and your anesthesiologist. Many of the anesthetics that can trigger this are associated with general anesthesia so performing these under local anesthesia may be an option for you.
Hope that helps
It is good to know the diagnosis in advance, and with proper handling in a hospital, surgery can usually be performed. Avoiding agents that may trigger it is critical. Good luck.
Surgery in patients with a history of malignant hyperthermia
It is possible to have surgery for patients who had have an episode of malignant hyperthermia, or who have a family history of malignant hyperthermia.
We generally perform these cases at UCLA Hospital rather than in our private surgery center. It is probably wise to do such cases at a top hospital rather than in a private surgery center, although with the proper levels of accreditation every surgery center should have Dantrolene on hand, and specific protocols for how to treat malignant hyperthermia.
Specific steps are taken during the delivery of the anesthetic that start preoperatively and continue until the patient leaves the recovery area.
Obviously a top flight anesthesiologist is required for surgeon and patient confidence!!!
Certainly the neck procedure can be done under local anesthesia.
Malignant hyperthermia is a rare genetic disease that is triggered by certain drugs used for general anesthesia that causes run away hyper-metabolism with elevated body temperature, rapid heart rate and acidosis. The condition is potentially life threatening. Malignant hyperthermia is triggered by certain anesthesia gases such as those commonly used in the performance of general anesthesia. Example include sevoflurane, desflurane, and enflurance. Depolarizing agents used to relax muscles during general anesthesia are also to trigger this hypermetabolic stated in people who are susceptible. This include succinylcholine, decamethonium and certain other drugs.
Not all aesthetic agents pose a risk. Local anesthetic are considered safe such as lidocaine. Opiates including fentany and anti-anxiety drugs such as valium are considered safe.
The neck liposuction can be very safely performed under local anesthesia. Depending on the nasal work you need, many surgeons would be comfortable performing this under local with a sedation consisting of drugs that are not going to trigger malignant hyperthermia.
Medical and Anesthetic Evaluation
If you have had a full workup re Malignant Hyperthermia, and are positive, then with careful thoughtful planning you can have surgery avoiding the anesthetic triggers. This need to be discussed and planned in advance with a competent plastic surgeon.
Malignant Hyperthermia and Elective Surgery
If you had malignant hyperthermia during a previous surgery, you may consider having the surgeries done with avoidance of certain general agents and depolarizing muscle relaxants. You need to be seen by a board certified plastic surgeon and his or her anesthesiologist to sort out exactly what the risk is, what triggered the previous episode, and whether these two surgeries can be safely performed. The two could be performed under local and sedation, but you need to be examined properly. Kenneth Hughes, MD Los Angeles, CA