Patients with susceptibility to malignant hyperthermia (MH) can be successfully managed on an outpatient basis after 4 h of postoperative monitoring . Triggering agents include volatile inhalation agents such as halothane, enflurane, desflurane, isoflurane and sevof-lurane. Even trace amounts of these agents lingering in an anesthesia machine or breathing circuit may precipitate an MH crisis. Succinylcholine and chlopromazine are other commonly used medications, which are known triggers of MH. However, many non-triggering medications may be safely used for local anesthesia, sedation-analgesia, postoperative pain control, and even general anesthesia . Nevertheless, anesthesia for patients suspected of having MH susceptibility should not be performed in an office-based setting. A stan dardized protocol to manage MH (available from the Malignant Hyperthermia Association of the United States, MHAUS) and supplies of dantrolene and cold intravenous fluids should be available for all patients.
Preferably, patients with MH susceptibility should be referred to an anesthesiologist for prior consultation. Intravenous dantrolene  and iced intravenous fluids are still the preferred treatment. MHAUS may be contacted at 800 - 98MHAUS and the MH hotline is 800-MH-HYPER.
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