Anaesthesia for caesarean delivery of a malignant hyperthermia susceptible parturient.

The anaesthetic management for Caesarean delivery of a parturient with a strong family history of malignant hyperthermia (MH) is presented. Before surgery an anaesthetic machine that was in regular use was prepared by replacing all rubber or disposable components and flushing with O2 at 10 L.min-1 for one hour. Dantrolene prophylaxis was not used, and the patient received a bupivacaine and fentanyl spinal anaesthetic. Hypotension was treated with ephedrine. Current management of the MH patient no longer mandates a dedicated vapour-free machine, dantrolene is not indicated as pre-treatment, and amide local anaesthetics are considered safe. The role of vasopressors and ergot preparations is less clear.