Malignant Hyperthermia and Adverse Metabolic Reactions Under Anesthesia

Abstract

Abstract Life-threatening adverse metabolic reactions during anesthesia are rare events that may arise from a variety of disease states. Rare diseases are not commonly encountered during routine anesthesia training experiences, yet anesthesia providers are expected to provide expert-level diagnosis and treatment of these conditions when they do occur. Managing these conditions can also present unique challenges to effective systems-based practice as well as interpersonal and communication skills. This simulation uses a high-fidelity manikin and is intended to provide anesthesia residents and medical students with the knowledge and skills needed to accurately diagnose a malignant hyperthermic crisis and apply an effective treatment plan for the intraoperative and postoperative periods. This module has been used in the simulation curriculum of the University of Miami Leonard M. Miller School of Medicine's anesthesiology residency program. Early curriculum revisions were made in the first 2 months, based on anonymous feedback from participants. Participants were asked to evaluate the success with which each of the learning goals was met on a four-point scale with potential responses ranging from: completely, most of the time, occasionally, not at all. Data for 56 residents collected over 10 months from anonymous postsession evaluations indicated that 89.2% believed all goals were met “completely.” In the aftercare period, many of the trainees admitted that the patient counseling scenario was particularly challenging. There was a heavy reliance on the use of medical jargon and very few sought to probe the simulated patient's understanding of the preceding conversation. These failures have been identified as two significant barriers to effective physician-patient education. Anesthesiology trainees may have fewer opportunities to deliver bad news, explain medical conditions, or provide patient education when compared to their counterparts in other specialties. It also suggests an opportunity for new doctor-patient communication curriculum development for anesthesiology trainees, beyond the usual pre-anesthetic counseling.

Keywords

• Crisis Management
• Malignant Hyperthermia
• Crisis Intervention