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.