Methods
Secondary to a family history of MH, the decision was made to avoid triggering volatile anesthetics such as isoflurane, sevoflurane, and desflurane. The anesthesia machine was flushed per manufacture protocol with high-flow oxygen and charcoal filters.1Preoperative management involved oral midazolam (0.5mg/kg for a total of 8.5mg) and inhaled nitrous oxide to achieve mild sedation and anxiolysis for IV placement combined with distraction therapy and light restraint of extremity by staff. Intravenous 15mcg fentanyl, 1mg midazolam, and inhaled nitrous was used for induction; the patient was briefly bradycardic to a heart rate of 57 but resolved spontaneously. Rocuronium was used for neuromuscular blockade and intubation was performed successfully on first attempt under direct visualization with a 3.5mm cuffed endotracheal tube and a miller 1.5 blade. For maintenance anesthesia, nitrous oxide and a remifentanil infusion was administered. For neuromuscular reversal, sugammadex was used and the patient tolerated the procedure without difficulty and was discharged on the same day as the procedure.