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Child has undescended testicles, has Prader-Willi syndrome and hypotonia. Is it true that only inhalational anesthesia may trigger malignant hypothermia?

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Posted on Sun, 1 Jul 2012
Question: Hi,
Can i get the answer from a pediatric anesthesiologist. I have a 4 year old son and we are planning for his orchiopexy surgery. He has 2 undescended testicles. He has prader XXXXXXX syndrome which is characterised by hypotonia etc. We have come to know that only inhalational anesthesia triggers malignant hypothermia. Although he is not predisposed to malignant hypothermia(we are told by our doctor), we do not want to take any risk since he has some muscle disorder i.e hypotonia. Our anestheist also told that he is going to avoid any muscle relaxants and a pws expert doctor also advised thus "Although there is no indication of a predisposition to malignant hyperthermia in PWS, depolarizing muscle relaxants (i.e., succinylcholine) should be avoided unless absolutely necessary".
Is it true that only inhalational anesthesia may trigger malignant hypothermia? Can we do away with this very small amount of risk by using only intravenous anesthesia and not using any inhalational anesthesia for orchiopexy surgery which may take about 1 hour. What are the problems and complications of using only intravenous anesthesia? Can surgery be performed under only intravenous anesthesia in children?

Please advice.
doctor
Answered by Dr. S. C. Parakh (32 hours later)
Hi,
Thanks for your query.
I feel your son can safely undergo surgery for undescended testicles. Earlier the surgery is done, the better it is for the child.

There is no need to worry about the malignant hyperthermia (it is not "malignant hypothermia"). all inhalational anaesthetic agents do not cause malignant hyperthermia. Anaesthesia can be managed without the muscle relaxants.

Though the surgery can be performed with total intravenous anaesthesia, a combination of intravenous and inhalational (with inhalational anaesthetic agents which are not associated with malignant hyper pyrexia) can be used.

Alternatively, spinal anaesthesia is a good option. In this technique, a local anaesthetic agent is injected around the spinal cord. This does not allow the pain impulses to reach the brain and patient does not feel pain. This injection is given through the spaces between the bones of back bone. Many anaesthesiologists are experts at paediatric spinal anaesthesia.

I hope I have answered your query.
Please feel free to get back in case of any further doubts or clarifications.

Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. S. C. Parakh (16 hours later)
Sir,
Thank you for the reply.
So do you mean to say that the surgery can be performed by using only spinal anaesthesia without the help of any other form of anesthesia? I would like to understand if spinal anesthesia can be used alone for the entire duration of surgery? and if it should be used in conjunction with another form of anesthesia what would the best available form of anesthesia be?

Thank you.
doctor
Answered by Dr. S. C. Parakh (30 minutes later)
Hi,

The operation in question is possible under spinal anesthesia alone. However, since the child is small some type of medication will be required to keep him sedated. These sedative drugs have nothing to do with malignant hyperthermia or Hypotonia of muscle or myopathy.

I understand you are located at Rajahmundry. Certainly there must be some anesthesiologist at Rajahmundry who can administer pediatric spinal anesthesia.

I hope this answers your query to your satisfaction.

Please feel free to get back if there is any doubt or you need further clarification.

Thanks.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. S. C. Parakh

Anesthesiologist

Practicing since :1969

Answered : 3 Questions

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Child has undescended testicles, has Prader-Willi syndrome and hypotonia. Is it true that only inhalational anesthesia may trigger malignant hypothermia?

Hi,
Thanks for your query.
I feel your son can safely undergo surgery for undescended testicles. Earlier the surgery is done, the better it is for the child.

There is no need to worry about the malignant hyperthermia (it is not "malignant hypothermia"). all inhalational anaesthetic agents do not cause malignant hyperthermia. Anaesthesia can be managed without the muscle relaxants.

Though the surgery can be performed with total intravenous anaesthesia, a combination of intravenous and inhalational (with inhalational anaesthetic agents which are not associated with malignant hyper pyrexia) can be used.

Alternatively, spinal anaesthesia is a good option. In this technique, a local anaesthetic agent is injected around the spinal cord. This does not allow the pain impulses to reach the brain and patient does not feel pain. This injection is given through the spaces between the bones of back bone. Many anaesthesiologists are experts at paediatric spinal anaesthesia.

I hope I have answered your query.
Please feel free to get back in case of any further doubts or clarifications.