I wish to thank you and to applaud you for the efforts that you have made to improve patient safety within your state and for making your information available to all, therefore improving patient safety throughout the United States.
I am reviewing literature to review our current procedure and physician orders for the prevention, recognition, and treatment of a malignant hyperthermia crisis and reviewed your 2008 article on that subject. I wish to bring to your attention a possible misleading statement on page 92 under “Screening.” Under the bullet “Obtain an anesthetic history to identify patients at risk for MH [malignant hyperthermia]: If the patient has not had general anesthesia before [italics added], does the patient know of a blood relative who had a bad reaction to anesthesia?” even if the patient has had general anesthesia before, the question, “Do you know of a blood relative who had a bad reaction to anesthesia?” is still appropriate, as MH-susceptible persons may have had a general anesthetic with triggering agents and may not have had a MH crisis or the reaction was not severe enough to be recognized or was misdiagnosed. Therefore, I feel the statement “If the patient has not had general anesthesia before” should be removed from that bullet point.
I thank Ms. Hansbrough for her perceptive comments. It is appropriate to modify the strategy to state that all patients requiring general anesthesia, whether they have been anesthetized previously or not, should be questioned as to a personal or family history of an unexpected adverse reaction to anesthesia, especially involving marked temperature elevation and/or muscle breakdown.