We suggest similar premedication for MH suspected or susceptible patients compared with patients with no disposition to develop MH.
(weak recommendation, level of evidence 2-)
Preoperative treatment with dantrolene is not recommended
(evidence level 2-).
Choice of anaesthetics
Only trigger free anaesthesia should be used in all MH suspected or susceptible patients.
(Strong recommendation, best practice statement)
Regional anaesthesia (e.g. neuraxial, peripheral nerve block or local anaesthesia) or trigger free general anaesthesia should be used avoiding all volatile anaesthetics and succinylcholine and after proper preparation of the anaesthetic machine (see here).
We recommend standard anaesthesia monitoring in MH suspected or susceptible patients.
(weak recommendation, evidence level 2-).
This should include at least ECG, pulse oximetry, non-invasive blood pressure and body temperature measurements. The use of further or extended monitoring depends on type of anaesthesia (waveform capnography, end-tidal CO2 and O2 in general anaesthesia) and/or comorbidity.
We suggest MH suspected or susceptible patients receive standard care in the recovery room (PACU) after anaesthesia.
(weak recommendation, evidence level 4).
There is no evidence to support elective ICU management of MH susceptible patients after uneventful trigger free anaesthesia. Factors other than MH susceptibility (e.g. blood pressure, heart rate, pain, nausea, vomiting) will determine the length of stay in the recovery room.
MH susceptible patients may be anaesthetized in outpatient settings avoiding all volatile anaesthetics and succinylcholine, following national guidelines for ambulant general anaesthesia.
(weak recommendation, level of evidence 4)
Laboratory blood samples
There is no need for any specific pre- or postoperative blood samples in MH susceptible patients.
(weak recommendation, evidence level 4)
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