MHAUS Newsletter, October 2006
In this issue:

MHAUS' 25th Anniversary Commemoration

MHAUS will commemorate its Silver Anniversary during its reception at the Hyatt Regency McCormick Place 2nd floor Conference Center 24C from 5:30 - 7:00 pm Monday, October 16.  We will be recognizing those who have contributed to our progress over this last quarter century, which includes reducing MH related deaths from 80 percent in 1981 to less than 5 percent today.  Some of our founders, past presidents and past executive directors will be present at this event.

Also to be recognized:

The Daniel Massik Award - Established by George Massik, a founding member of MHAUS, in memory of his son who died from MH. These Awards will provide a stipend of $2,000 for First Place and $1,500 for Second Place to an anesthesia resident/fellow or an anesthesiologist who is within five years of ending his/her training to attend the annual meeting of the American Society of Anesthesiologists Meeting or, in special circumstances, another meeting of similar merit.  The awards will be given to the primary author of the best manuscript concerning, malignant hyperthermia.  The purpose is to stimulate interest in MH research.
MHAUS Media Award - Recognizing the media representative who went above and beyond to understand MH and to help us educate the medical and lay publics.
MHAUS Hotline Partnership Award - This award recognizes special cases in which the 24/7 MH Hotline was used to help save lives, solving MH cases in real time via telephone.
Outstanding Dedication to MHAUS Award - This honors the person who contributed in a unique way to the treatment or prevention of MH during the past year.

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MHAUS Sessions, Scientific Exhibits, and Posters

Scientific Exhibit - History of MHAUS, focusing on innovations in diagnosis, treatment and prevention over its 25 years of existence
During Exhibit Hours on October 15, 16 and 17
Henry Rosenberg, MD
The exhibit celebrates the quarter century of accomplishments of MHAUS.  It provides a graphic display of the history of MHAUS and the progress in the understanding and management of this potentially fatal inherited disorder of anesthesia.  The exhibit will demonstrate how and when MHAUS introduced such successful programs as the hotline, the interactive web site, educational brochures, protocols and policies as well as a wide array of print material.  In looking back over 25 years, enormous progress has been made in understanding how to rapidly diagnose a clinical episode of MH, the most effective steps in treatment and management and in laboratory testing.  An organization such as MHAUS is only as strong as the people who are dedicated to its mission. Those individuals will be identified and recognized in the exhibit.

Panel Session - Controversies in Malignant Hyperthermia: Cases From the MHAUS Hotline
October 14th, 2006, 9:00 am - 11:00 am
Litman, Ronald S. D.O., Rosenberg, Henry M.D., Tobin, Joseph R. M.D., Kaplan, Richard F. M.D.
This is a panel session reviewing management and outcomes of real MH Hotline cases. By using actual calls to the 24/7 MH Hotline, the panel will discuss controversies in MH, including the role of genetic testing vs. muscle biopsy, dantrolene availability in freestanding surgical centers, postoperative MH, and a critical look at diseases or patient
conditions thought to be associated with MH, such as heat stroke, exercise-induced rhabdomyolysis, and the dysrtophinopathies. The panel will also encourage audience participation, including questions about their own cases, and the opinons of the panelists, who are all MH Hotline consultants.

Poster Session - Postoperative Malignant Hyperthermia – Relative Incidence and Clinical Characteristics
October 15th, 2006
9:00 am - 11:00 am
Litman, Ronald S. D.O, Joseph Tobin, MD, Richard Kaplan, MD, Chris Flood, MD
This poster represents a research study performed by Dr. Chris Flood, an anesthesiology resident at the University of Pennsylvania. Dr. Flood enlisted the assistance of three MH hotline consultants, and analyzed the North American Malignant Hyperthermia Registry, to discover and examine postoperative MH cases and their clinical characteristics. This work took 2nd prize for the Massik award, given annually by MHAUS for excellence in an MH-related manuscript by a trainee or junior faculty member.

Scientific Paper/Poster Session - Neuromuscular Disorders and the Risk of Malignant Hyperthermia
October 16, 2006
9:00 am - 11:00 am
Stephen J. Gleich, B.S., Denise J. Wedel, M.D., Randall P. Flick, M.D., M.P.H.  Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
Introduction: It is assumed those children with known or suspected neuromuscular disorders (NMD) are at increased risk for malignant hyperthermia (MH). (1, 2) Previous reports have suggested relationships between a variety of NMDs and MH, including Duchenne muscular dystrophy, osteogenesis imperfecta, myotonia congenita, and Schwartz-Jampel syndrome. Kearns-Sayre syndrome and other mitochondrial disorders have also been associated with MH. (3) However, no conclusive data exists to demonstrate that these disorders are indeed related to an increased risk of MH. Nevertheless, most children undergoing muscle biopsy for a suspected myopathy are managed with a non-triggering anesthetic. This requires preparation of the anesthesia machine and establishment of IV access prior to induction. It is therefore both inconvenient and undesirable to provide a non-triggering anesthetic unless it is clearly indicated. (4)
Of 274 pediatric patients who received a triggering anesthetic for muscle biopsy, none developed MH. The incidence of MH in this population is 1.09% or less with 95% confidence.
(1) Britt B.A. et al., Can Anesth Soc J, 1970 (2) Heytens L. et al., BJA, 1992 (3) Ohtani Y. et al., Brain Dev, 1985 (4) McGraw T.T. et al., Can J Anaesth, 1989

Don't Forget This Number! 1070

This will be the exhibit booth number for MHAUS in the ASA Annual Meeting Exhibit Hall.  Our very latest educational brochures, manuals, articles, and our in-service kit will be available.  We will also offer our 25th Anniversary bags and pens for those of you who fill out a survey and our 25th Anniversary commemorative book for new members and renewing members.

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FDA Hears MHAUS, Result is New Package Insert

Baxter has become the first pharmaceutical company to include a statement about unexpected hyperkalemic cardiac arrest in the package insert information for inhalation anesthetic agents.  This developed from an initiative two years ago when MHAUS petitioned the FDA to include the statement, because of hyperkalemic arrest in two young patients with occult DMD.  The web site for the new insert is on page 15 at http://www.fda.gov/cder/foi/label/2006/020118s011lbl.pdf.

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Take the Challenge - Test Yourself on the MH Hotline Case of the Month

You are probably aware of an MHAUS signature service, our 24/7 MH Hotline, where the medical team can call us at anytime to get live, real time advice on handling an MH episode.  Since February of 2005 we have been posting an "MH Case of the Month" taken from an actual MH Hotline case on our web site.  This will challenge you, and help make sure your team is up to date with the latest management tools and techniques for an MH case.  See the latest case and take the challenge!  The answers are posted the following month.  We hope this offers you an invaluable educational experience.

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