Local anesthesia and malignant hyperthermia - Review of the literature andrecommendations for the dermatologic surgeon

BACKGROUND. Malignant hyperthermia (MH) is a rare syndrome that is a major cause of anesthetic-related morbidity and mortality in otherwise well patie nts. The role of local anesthetics, stress, and epinephrine in inducing thi s syndrome has been subjected to controversy. OBJECTIVE. TO examine the role of local anesthetics, stress, and epinephrin e in producing clinically relevant adverse effects in patients with MH. METHODS. A critical review of the literature. RESULTS. Local anesthesia is safe for use in usual doses in MH-susceptible patients. The role of stress and epinephrine in precipitating episodes of M H is likely minimal, but controversy remains in the anesthesia and dental l iterature. CONCLUSION. Recommendations for diagnosis, treatment, and safety precaution s to be taken by dermatologic surgeons when treating MH patients are made.