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Malignant hyperthermiaMMalignant hyperthermiaMalignant hyperthermiaEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)NANAConditions and diseasesCaregivers Adult (19+)NA2015-02-09T05:00:00ZKelly Shackell, RN;Mark F. Levine, MBBCh, FRCPC;Sheila Riazi, MSc, MD, FRCPC;Helen Forrest, ANPE12.000000000000041.00000000000001404.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what to do if your child is at risk for malignant hyperthermia and has to have surgery.</p><h2>What is malignant hyperthermia?</h2><p>Malignant hyperthermia (MH) is a rare, but potentially deadly disorder of the muscles. It can be triggered with the use of <a href="/article?contentid=1261&language=English">general anaesthesia</a> during surgery. What happens to the body in patients with MH is complex. When certain individuals are exposed to anaesthetic gases and certain muscle relaxants used to put a patient to sleep during surgery, calcium levels in the muscle cells increase. This causes the muscles to have difficulty relaxing. As a result, there is a rapid increase in metabolism in the body, which leads to a rise in metabolic acids and changes to electrolytes in the patient’s bloodstream. This reaction will cause the heart to start pumping rapidly, the breathing rate to become very fast, and the core body temperature to rise very rapidly (to more than 40 degrees Celsius).<br></p><h2>Key points</h2> <ul> <li>Malignant hyperthermia (MH) is a rare, inherited metabolic disorder that is triggered, or activated, by commonly used general anaesthetic gases or anaesthetic-related muscle relaxant.</li> <li>If you are aware of any family history of MH, please notify your surgeon and ask for a consultation with the pre-anaesthesia clinic.</li> <li>During the procedure, the anesthesiologist will avoid anesthetic gases and muscle relaxants that are known to trigger reactions. This will almost completely remove the likelihood of an MH reaction occurring.</li> <li>Your child will be closely monitored for a minimum of 2 hours in the recovery room.</li> <li>You may take your child home on the day of surgery if there have not been any problems during the aanesthesia.</li> <li>If you see any signs of a reaction, please return to hospital or head to your nearest emergency department, and asked to be assessed by a member of the anaesthesia team.</li> </ul><h2>Who is affected?</h2> <p>Malignant hyperthermia is an inherited condition that only requires one parent to pass on the gene. Not everyone who has the defective gene will develop MH when exposed to anaesthetic gases or muscle relaxants. Malignant hyperthermia is believed to occur in one in 15,000 to 30,000 children who undergo anaesthesia. Therefore, close monitoring of patients undergoing anaesthesia is essential, for quick recognition and administration of rescue medications. Most MH reactions occur in the operating room (OR); however, in rare circumstances, a reaction may occur up to 6 hours after receiving a triggering anaesthetic.</p><h2>What if I have a family history of MH and my child needs surgery?</h2><p>You may not be aware that your child is at risk for MH unless a family member has had a life-threatening event resembling MH during anaesthesia or has had a test (a muscle biopsy) that confirms they have the condition. When undergoing any procedure that involves an anaesthetic, it is important to provide a detailed family history to your anesthesiologist, including incidents of high temperature, muscle stiffness, or death in family members who have had anaesthesia.</p><p>If you are aware of any family history of MH, please notify your surgeon and ask for a consultation with the <a href="http://www.sickkids.ca/Anesthesia/programsservices/preanesthesia-assessment-clinic/Preanesthesia%20Assessment%20Clinic.html">pre-anaesthesia clinic.</a> Anyone who is closely related to someone else who has experienced MH is considered susceptible (at risk) and must be managed accordingly until their status is confirmed. The consultation can be done over the phone or by appointment.</p><p>The pre-anaesthesia clinic nurses and the anaesthesiologist will review your child’s medical history. If there is a family history, a previous suspected reaction to anesthesia, or a positive muscle biopsy, then your child will be considered “malignant hyperthermia susceptible (MHS)”, meaning more at risk for developing an MH reaction. The anaesthesiologist would then use a special anaesthetic that does not contain the medications that cause the reaction.</p><p>A special type of muscle biopsy can confirm the diagnosis in suspected cases of MH. Muscle biopsy testing must be done at a hospital that is able to perform this special type of test, which is called the caffeine-halothane contracture test. Only one hospital in Canada is set up to perform this test. A significant amount of thigh muscle is required to complete the test. Due to these limitations, biopsies are rarely performed in children and a family history is usually used for a MHS diagnosis.</p><h2>Day of surgery</h2><p>On the day of surgery, your doctor will talk to you about your family history and the plan of care for your child. The surgery will be scheduled early in the day to allow the anaesthesiologist time to prepare the anaesthetic gas machines for your child’s procedure. Before the surgery, the anaesthesiologist will flush the machine with oxygen to ensure that there are no traces of the triggering anaesthetic gas from previous use. During the procedure, the anaesthesiologist will avoid anesthetic gases and muscle relaxants that are known to trigger MH reactions—this will almost completely remove the likelihood of an MH reaction from occurring. In the operating room, the anaesthesiologist will monitor your child closely for changes in breathing, heart rate, and heart rhythm, and will look for muscle stiffness. As well, the doctor will continuously monitor your child’s temperature and look for any other indications of an MH reaction.</p><h2>After surgery</h2><p>After the operation is complete, your child will be accompanied by the anaesthesiologist to the <a href="/article?contentid=1262&language=English">post-anaesthetic care unit</a> (PACU) for further monitoring for signs of an MH reaction and to recover from the procedure. The anesthesiologist will inform the nurses in the recovery room of your child’s history and what kind of monitoring is required. As recommended by the <a target="_blank" href="http://www.mhaus.org/">Malignant Hyperthermia Association of the United States</a> (MHAUS), your child will be closely monitored for a minimum of two hours in the recovery room, with vital signs being checked every 15 minutes. A heart rhythm monitor, temperature probe (a special thermometer), and an oxygen sensor will also be placed on your child for close observation. The anaesthesiologist will be notified by the nurse of any changes to your child’s condition. The likelihood of a reaction occurring after a trigger-free anaesthetic is very small. If no signs of a reaction develop during the first two hours of close monitoring, and your child has met the requirements for discharge, your nurse will contact the anaesthesiologist in charge of your child’s care to confirm that your child can be discharged home or be transferred to a surgical nursing unit. Transfer to a unit may be necessary for recovery from the operation or for more monitoring and nursing care. The MHAUS recommends that patients go home on the same day as surgery if they have not had problems during anaesthesia.</p><h2>Staying in hospital</h2><p>If your child is to be transferred to an inpatient ward, your nurse will give a report to the surgical unit nurse about your child’s stay in the recovery room and any further monitoring that is required. The MHAUS recommends that after the recovery room stay, a patient susceptible to MH should be monitored every hour for four hours, then every four hours for 24 hours. Your nurse will monitor your child for the signs listed above, in addition to any further instructions from the surgical team. If any concerns arise with your child, the nurse will contact the surgical team immediately. If your child’s stay is uneventful, the surgical team will discharge them when appropriate. Follow the physician’s instructions once the child is at home.</p><p>If you require any further information, please do not hesitate to contact your family doctor or surgeon.</p><h2>Further information</h2><h3>AboutKidsHealth.ca</h3><ul><li> <a href="/article?contentid=1261&language=English">General anaesthesia</a></li><li> <a href="/article?contentid=1166&language=English">Surgery: Getting ready for your child’s operation</a><br></li><li> <a href="/article?contentid=1262&language=English">Post anaesthetic care unit: Visiting your child in the PACU</a></li><li> <a href="/article?contentid=1252&language=English">Post operative and post anaesthesia: Caring for your child at home</a></li><li> <a href="/article?contentid=966&language=English">Temperature taking</a></li></ul><h3>Other online references<br></h3><ul><li> <a target="_blank" href="http://www.mhaus.org/">Malignant Hyperthermia Association of the United States</a></li><li> <a target="_blank" href="http://pie.med.utoronto.ca/">Toronto General Hospital</a></li></ul>
Hyperthermie maligneHHyperthermie maligneMalignant hyperthermiaFrenchPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)NANAConditions and diseasesCaregivers Adult (19+)NA2015-02-09T05:00:00ZKelly Shackell, RN;Mark F. Levine, MBBCh, FRCPC;Sheila Riazi, MSc, MD, FRCPC;Helen Forrest, ANPE12.000000000000041.00000000000001404.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Apprenez quoi faire si votre enfant est à risque d’hyperthermie maligne et doit subir une chirurgie.</p><h2>En quoi consiste l’hyperthermie maligne?</h2> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/PST_surgery_anesthesia_EN.jpg" alt="" /> </figure> <p>L’hyperthermie maligne (HM) est un trouble musculaire rare qui peut être mortel. L’HM peut être déclenchée par l’<a href="/article?contentid=1261&language=English">anesthésie</a> générale​ administrée dur​ant une chirurgie. L’HM provoque une réaction complexe de l’organisme. Lorsque les personnes atteintes d’HM sont exposées aux gaz anesthésiques et à certains relaxants musculaires administrés pour qu’elles dorment pendant une chirurgie, il se produit chez elles une augmentation des teneurs en calcium des cellules musculaires. Par suite de cette hausse du taux de calcium, les muscles se relâchent difficilement. Ce phénomène entraîne une accélération rapide du métabolisme, d’où une augmentation des acides métaboliques et des changements du taux d’électrolytes dans le sang. Cette réaction se traduit par un rythme cardiaque accéléré, un rythme respiratoire très rapide et une hausse très brusque de la température interne du corps (à plus de 40 degrés Celsius).​​​</p><h2>À retenir</h2> <ul> <li>L’hyperthermie maligne (HM) est un trouble métabolique héréditaire rare qui est déclenché par les gaz couramment utilisés à l’anesthésie générale ou par le relaxant musculaire associé.​</li> <li>Si vous être au courant d’antécédents d’HM dans la famille, assurez-vous de les signaler à votre chirurgien et de demander​ une consultation à la pre-anaesthesia clinic (clinique d’évaluation pré-anesthésique.</li> <li>Durant l’intervention, l’anesthésiste évitera d’utiliser tout gaz anesthésique et relaxant musculaire reconnus pour déclencher des réactions d’HM, ce qui éliminera presque entièrement les risques que votre enfant présente une réaction de ce type.</li> <li>Dans la salle de réveil, votre enfant sera surveillé de près pendant un minimum de 2 heures.</li> <li>Votre enfant pourra rentrer à domicile le jour même de la chirurgie si l’anesthésie n’a déclenché aucune réaction.</li> <li>Si vous observez tout signe de réaction une fois à domicile, assurez-vous d’amener votre enfant aux services d’urgence de Sick Kids ou à ceux situés les plus près de chez vous et y demandez qu’il soit examiné par un membre de l’équipe d’anesthésie.</li> </ul><h2>Qui est touché?</h2> <p>L’hyperthermie maligne est un trouble héréditaire qui n’exige qu’un seul parent soit du gène défectueux pour qu’il soit transmis aux enfants. Toutefois, les patients porteurs de ce gène ne sont pas nécessairement atteints d’HM s’ils sont exposés aux gaz anesthésiques ou aux relaxants musculaires. Selon les estimations, l’incidence de l’hyperthermie maligne serait de 1 sur 15 000 à 30 000 chez les enfants anesthésiés. Il est donc essentiel de surveiller de près les patients atteints d'HD anesthésique tant pour repérer rapidement toute réaction que pour administrer sans tarder des médicaments de secours. La plupart des réactions d’HD anesthésique se produisent dans la salle d’opération. Cependant, dans de rares cas, une réaction peut survenir jusqu’à 6 heures suivant l’administration de l’anesthésie.</p><h2>Qu’adviendra-t-il s’il y a des antécédents d’HM dans ma famille et que mon enfant a besoin d’une chirurgie?</h2> <p>Vous ne savez peut-être pas si votre enfant est​ à risque d’HM à moins qu’un membre de votre famille ait fait une réaction ayant mis sa vie en danger qui ressemblait à une réaction d’HM anesthésique ou ait fait l’objet un test de dépistage (biopsie musculaire) confirmant qu’il en était atteint. Pour tout acte médical auquel est associé un anesthésique, il est important de fournir à l’anesthésiste une explication détaillée de vos antécédents familiaux, dont les cas de fièvre, de rigidité musculaire ou de décès dus à une anesthésie chez un membre de votre famille.</p> <p>Si vous êtes au courant de tout antécédent familial d’HM, assurez-vous d’en informer votre chirurgien et de demander une consultation à la <a href="http://www.sickkids.ca/Anesthesia/programsservices/preanesthesia-assessment-clinic/Preanesthesia%20Assessment%20Clinic.html">pre-anaesthesia clinic ​</a> (clinique d’évaluation pré-anesthésique, site en anglais seulement). Tout proche parent d’une personne qui a fait une réaction d’HM anesthésique est jugé à risque et doit faire l’objet des précautions qui s’imposent jusqu’à ce qu’il soit confirmé qu’il présente ou non une susceptibilité à l'hyperthermie maligne (SHM). La consultation peut se faire par appel téléphonique ou sur rendez-vous.</p> <p>Le personnel infirmier de la clinique pré-anesthésique et l’anesthésiste examineront les antécédents médicaux de votre enfant. En présence d’antécédents familiaux d’HM, de réaction antérieure qui serait due à une anesthésie ou de résultat positif à une biopsie musculaire, ils considéreront que votre enfant présente une « susceptibilité à hyperthermie maligne » (SHM), ce qui veut dire qu’il est davantage à risque de faire une réaction de SM anesthésique.</p> <p>L’anesthésiste se servira alors d’un anesthésique particulier qui ne contient pas les médicaments provoquant la réaction. Un type particulier de biopsie musculaire peut confirmer le diagnostic dans les cas d’HM soupçonnée. Cette biopsie, qui s’appelle test de contracture halothane-caféine, doit être réalisée dans un hôpital doté des installations qui y sont nécessaires. Au Canada, un seul hôpital possède ces installations. De plus, pour effectuer ce test, il est nécessaire de prélever une quantité importante du muscle de la cuisse. Compte tenu de ces facteurs limitatifs, les biopsies musculaires sont rarement faites chez les enfants et le diagnostic de SHM repose généralement sur leurs antécédents familiaux.</p><h2>Jour de la chirurgie</h2><p>Le jour de la chirurgie, votre chirurgien vous parlera de vos antécédents familiaux et du plan de soins de votre enfant. La chirurgie sera prévue tôt dans la journée afin de permettre à l’anesthésiste de préparer les appareils servant à l’administration des gaz anesthésiques durant la chirurgie de votre enfant. Avant l’intervention, l’anesthésiste s’assurera d’évacuer à l’aide d’un flux d’oxygène toute trace du gaz anesthésique déclencheur ayant servi auparavant. Pendant l’intervention, il évitera d’utiliser tout gaz anesthésique et relaxant musculaire reconnus pour déclencher des réactions d’HM, ce qui éliminera presque entièrement les risques que votre enfant présente une réaction de ce type. Dans la salle d’opération, l’anesthésiste surveillera de près votre enfant pour déceler tout signe de rigidité musculaire et de changements dans son rythme respiratoire et sa fréquence ou son rythme cardiaque. De plus, tout au long de l’intervention, le chirurgien surveillera la température corporelle de votre enfant et repérera chez lui tout signe de réaction d’HM.</p><h2>Après la chirurgie</h2><p>Une fois la chirurgie terminée, l’anesthésiste accompagnera votre enfant à l’unité des soins postopératoires (PACU) non seulement pour le suivi postopératoire immédiat (phase de réveil), mais également pour le suivi des signes de réaction d’HM. L’anesthésiste renseignera le personnel infirmier de la PACU des antécédents de votre enfant et lui précisera de quel type de surveillance il doit faire l’objet. Comme le recommande la <a target="_blank" href="http://www.mhaus.org/">Malignant Hyperthermia Association of the United States</a> (association d’hyperthermie maligne des États-Unis), l’infirmier responsable de votre enfant le surveillera de près pour une durée minimale de 2 heures et vérifiera ses signes vitaux à des intervalles de 15 minutes. Votre enfant sera aussi relié à un moniteur de rythme cardiaque, à une sonde thermique (thermomètre particulier) et à une sonde d’oxygène. L’infirmier signalera à l’anesthésiste tout changement de l’état de votre enfant. Le risque que survienne une réaction suivant l’administration d’un anesthésique sans agents déclencheurs est très faible. Si aucun signe de réaction ne se manifeste durant les 2 premières heures de surveillance systématique de votre enfant et que celui-ci satisfait aux critères pour quitter le PACU, l’infirmier communiquera avec l’anesthésiste pour lui confirmer que votre enfant peut rentrer à domicile ou peut être acheminé à une unité de soins infirmiers postopératoires. Ce transfert peut être requis afin de continuer le suivi postopératoire et la surveillance des signes de réaction d’HM ainsi que pour l’administration de soins infirmiers. La MHAUS recommande que les patients rentrent à domicile le jour même de la chirurgie si l’anesthésie n’a déclenché aucune réactiona.</p><h2>Hospitalisation</h2><p>Si votre enfant doit être transféré à une unité d’hospitalisation, l’infirmier qui en a été responsable jusqu’ici renseignera celui qui le prendra en charge au sujet de sa surveillance dans la salle de réveil et de tout autre besoin de suivi. Selon les recommandations de la MHAUS, après avoir quitté la salle de réveil, un patient présentant une susceptibilité à l’HM doit faire l’objet d’un suivi sur une base horaire pendant une période de 4 heures, puis à des intervalles de 4 heures pendant une période de 24 heures. L’infirmier responsable de votre enfant surveillera ce dernier afin de repérer les signes énumérés ci-dessus et exécutera toute directive supplémentaire de l’équipe chirurgicale à qui il signalera immédiatement toute préoccupation. Si tout se déroule bien pendant cette période d’hospitalisation, l’équipe chirurgicale donnera à votre enfant son congé au moment approprié. Vous devrez suivre les directives du chirurgien une fois que vous rentrerez à domicile.</p><p>Si vous avez besoin de renseignements supplémentaires, veuillez communiquer avec votre médecin de famille ou votre chirurgien.</p><h2>Renseignements supplémentaires</h2><h3>AboutKidsHealth.ca</h3><ul><li> <a href="/article?contentid=1261&language=French">Anesthésie générale </a></li><li> <a href="/article?contentid=1166&language=French">Surgery: Getting ready for your child’s operation</a></li><li> <a href="/article?contentid=1262&language=French">Unité des soins postopératoires (PACU) : visiter votre enfant à la PACU</a><br></li><li> <a href="/article?contentid=1252&language=French">Soins postopératoires et postanesthésiques : comment prendre soin de votre enfant à domicile</a></li><li> <a href="/article?contentid=966&language=French">Prise de la température</a></li></ul><h3>Autres sources de renseignements en ligne</h3><ul><li> <a target="_blank" href="http://www.mhaus.org/">Malignant Hyperthermia Association of the United States</a></li><li> <a target="_blank" href="http://pie.med.utoronto.ca/">Toronto General Hospital</a></li></ul>

 

 

Malignant hyperthermia2549.00000000000Malignant hyperthermiaMalignant hyperthermiaMEnglishPain/AnaesthesiaChild (0-12 years);Teen (13-18 years)NANAConditions and diseasesCaregivers Adult (19+)NA2015-02-09T05:00:00ZKelly Shackell, RN;Mark F. Levine, MBBCh, FRCPC;Sheila Riazi, MSc, MD, FRCPC;Helen Forrest, ANPE12.000000000000041.00000000000001404.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Learn what to do if your child is at risk for malignant hyperthermia and has to have surgery.</p><h2>What is malignant hyperthermia?</h2><p>Malignant hyperthermia (MH) is a rare, but potentially deadly disorder of the muscles. It can be triggered with the use of <a href="/article?contentid=1261&language=English">general anaesthesia</a> during surgery. What happens to the body in patients with MH is complex. When certain individuals are exposed to anaesthetic gases and certain muscle relaxants used to put a patient to sleep during surgery, calcium levels in the muscle cells increase. This causes the muscles to have difficulty relaxing. As a result, there is a rapid increase in metabolism in the body, which leads to a rise in metabolic acids and changes to electrolytes in the patient’s bloodstream. This reaction will cause the heart to start pumping rapidly, the breathing rate to become very fast, and the core body temperature to rise very rapidly (to more than 40 degrees Celsius).<br></p><h2>Key points</h2> <ul> <li>Malignant hyperthermia (MH) is a rare, inherited metabolic disorder that is triggered, or activated, by commonly used general anaesthetic gases or anaesthetic-related muscle relaxant.</li> <li>If you are aware of any family history of MH, please notify your surgeon and ask for a consultation with the pre-anaesthesia clinic.</li> <li>During the procedure, the anesthesiologist will avoid anesthetic gases and muscle relaxants that are known to trigger reactions. This will almost completely remove the likelihood of an MH reaction occurring.</li> <li>Your child will be closely monitored for a minimum of 2 hours in the recovery room.</li> <li>You may take your child home on the day of surgery if there have not been any problems during the aanesthesia.</li> <li>If you see any signs of a reaction, please return to hospital or head to your nearest emergency department, and asked to be assessed by a member of the anaesthesia team.</li> </ul><h2>Who is affected?</h2> <p>Malignant hyperthermia is an inherited condition that only requires one parent to pass on the gene. Not everyone who has the defective gene will develop MH when exposed to anaesthetic gases or muscle relaxants. Malignant hyperthermia is believed to occur in one in 15,000 to 30,000 children who undergo anaesthesia. Therefore, close monitoring of patients undergoing anaesthesia is essential, for quick recognition and administration of rescue medications. Most MH reactions occur in the operating room (OR); however, in rare circumstances, a reaction may occur up to 6 hours after receiving a triggering anaesthetic.</p><h2>What if I have a family history of MH and my child needs surgery?</h2><p>You may not be aware that your child is at risk for MH unless a family member has had a life-threatening event resembling MH during anaesthesia or has had a test (a muscle biopsy) that confirms they have the condition. When undergoing any procedure that involves an anaesthetic, it is important to provide a detailed family history to your anesthesiologist, including incidents of high temperature, muscle stiffness, or death in family members who have had anaesthesia.</p><p>If you are aware of any family history of MH, please notify your surgeon and ask for a consultation with the <a href="http://www.sickkids.ca/Anesthesia/programsservices/preanesthesia-assessment-clinic/Preanesthesia%20Assessment%20Clinic.html">pre-anaesthesia clinic.</a> Anyone who is closely related to someone else who has experienced MH is considered susceptible (at risk) and must be managed accordingly until their status is confirmed. The consultation can be done over the phone or by appointment.</p><p>The pre-anaesthesia clinic nurses and the anaesthesiologist will review your child’s medical history. If there is a family history, a previous suspected reaction to anesthesia, or a positive muscle biopsy, then your child will be considered “malignant hyperthermia susceptible (MHS)”, meaning more at risk for developing an MH reaction. The anaesthesiologist would then use a special anaesthetic that does not contain the medications that cause the reaction.</p><p>A special type of muscle biopsy can confirm the diagnosis in suspected cases of MH. Muscle biopsy testing must be done at a hospital that is able to perform this special type of test, which is called the caffeine-halothane contracture test. Only one hospital in Canada is set up to perform this test. A significant amount of thigh muscle is required to complete the test. Due to these limitations, biopsies are rarely performed in children and a family history is usually used for a MHS diagnosis.</p><h2>Day of surgery</h2><p>On the day of surgery, your doctor will talk to you about your family history and the plan of care for your child. The surgery will be scheduled early in the day to allow the anaesthesiologist time to prepare the anaesthetic gas machines for your child’s procedure. Before the surgery, the anaesthesiologist will flush the machine with oxygen to ensure that there are no traces of the triggering anaesthetic gas from previous use. During the procedure, the anaesthesiologist will avoid anesthetic gases and muscle relaxants that are known to trigger MH reactions—this will almost completely remove the likelihood of an MH reaction from occurring. In the operating room, the anaesthesiologist will monitor your child closely for changes in breathing, heart rate, and heart rhythm, and will look for muscle stiffness. As well, the doctor will continuously monitor your child’s temperature and look for any other indications of an MH reaction.</p><h2>After surgery</h2><p>After the operation is complete, your child will be accompanied by the anaesthesiologist to the <a href="/article?contentid=1262&language=English">post-anaesthetic care unit</a> (PACU) for further monitoring for signs of an MH reaction and to recover from the procedure. The anesthesiologist will inform the nurses in the recovery room of your child’s history and what kind of monitoring is required. As recommended by the <a target="_blank" href="http://www.mhaus.org/">Malignant Hyperthermia Association of the United States</a> (MHAUS), your child will be closely monitored for a minimum of two hours in the recovery room, with vital signs being checked every 15 minutes. A heart rhythm monitor, temperature probe (a special thermometer), and an oxygen sensor will also be placed on your child for close observation. The anaesthesiologist will be notified by the nurse of any changes to your child’s condition. The likelihood of a reaction occurring after a trigger-free anaesthetic is very small. If no signs of a reaction develop during the first two hours of close monitoring, and your child has met the requirements for discharge, your nurse will contact the anaesthesiologist in charge of your child’s care to confirm that your child can be discharged home or be transferred to a surgical nursing unit. Transfer to a unit may be necessary for recovery from the operation or for more monitoring and nursing care. The MHAUS recommends that patients go home on the same day as surgery if they have not had problems during anaesthesia.</p><h2>Staying in hospital</h2><p>If your child is to be transferred to an inpatient ward, your nurse will give a report to the surgical unit nurse about your child’s stay in the recovery room and any further monitoring that is required. The MHAUS recommends that after the recovery room stay, a patient susceptible to MH should be monitored every hour for four hours, then every four hours for 24 hours. Your nurse will monitor your child for the signs listed above, in addition to any further instructions from the surgical team. If any concerns arise with your child, the nurse will contact the surgical team immediately. If your child’s stay is uneventful, the surgical team will discharge them when appropriate. Follow the physician’s instructions once the child is at home.</p><p>If you require any further information, please do not hesitate to contact your family doctor or surgeon.</p><h2>Going home after surgery</h2><p>If your child can be discharged and sent home, the nurse will review the discharge instructions with you. If you have any questions, please do not hesitate to ask your health care professional team. At home, we suggest that you watch your child for the signs listed below. In the unlikely event that you see any changes, you must take your child to your nearest emergency department, or return to Sick Kids (going straight to the emergency department). At the hospital your child should be assessed by a member of the anaesthesia team.</p><p>Signs to watch for:<br></p><ul><li> <a href="/article?contentid=966&language=English">Core temperature</a> (taken in the child’s ear or rectum) greater than 38.5 degrees</li><li>Muscle stiffness (e.g., stiff legs or cramps)</li><li>Rapid breathing</li><li>Blue discolouration of the skin or tongue</li><li>Dark, red-coloured urine</li></ul><h2>Further information</h2><h3>AboutKidsHealth.ca</h3><ul><li> <a href="/article?contentid=1261&language=English">General anaesthesia</a></li><li> <a href="/article?contentid=1166&language=English">Surgery: Getting ready for your child’s operation</a><br></li><li> <a href="/article?contentid=1262&language=English">Post anaesthetic care unit: Visiting your child in the PACU</a></li><li> <a href="/article?contentid=1252&language=English">Post operative and post anaesthesia: Caring for your child at home</a></li><li> <a href="/article?contentid=966&language=English">Temperature taking</a></li></ul><h3>Other online references<br></h3><ul><li> <a target="_blank" href="http://www.mhaus.org/">Malignant Hyperthermia Association of the United States</a></li><li> <a target="_blank" href="http://pie.med.utoronto.ca/">Toronto General Hospital</a></li></ul>Malignant hyperthermia

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