ESRA19-0214 Regional anesthesia as a safe approach in the malignant-hyperthermia susceptible patient scheduled for cesarean delivery

Background and aims Malignant hyperthermia (MH) is an autosomal dominant disorder, characterized by a life-threatening hypermetabolic state that develops following patient exposure to triggers such as volatile anesthetic agents and depolarizing neuromuscular blockers. Methods An otherwise healthy, 33-year-old pregnant women with no previous anesthetic history of general anesthesia (GA) was scheduled for cesarean delivery. However, the patient had family history (first-degree cousin) of MH during GA. We decided to perform spinal anesthesia (L3-L4 level) with 8 mg of hyperbaric bupivacaine 0.5% plus 2 mcg sufentanyl, achieving surgical anesthesia up to T6 level bilaterally. Due to the potential risk of MH, precautions were taken to avoid all possible triggers in the event of a block failure such as notifying all the anesthetic staff, ‘washing out’ the ventilator machine, making Dantrolene available, storing cold saline fluids for infusion and removing trigger agents from the operating room. Results A satisfactory spinal block was achieved, which allowed surgery without complications. Throughout the entire procedure, the patient remained complaint-free and hemodynamically stable without evidence of MH. Conclusions Patients susceptible to MH may be submitted to GA if triggers are avoided, but the procedure is not risk-free. While several strategies for MH-prevention under GA exist, regional anesthesia proves to be the technique of choice, not only for its well-known advantages in obstetric surgery, but also because local anesthetics are considered safe in this setting, allowing an uneventful anesthesia with no exposure to MH-triggering agents.