National news agencies have reported the tragic death of an 18 year-old girl in Boca Raton, Florida, after plastic surgery to correct asymmetric breasts. The reported cause of death was Malignant Hyperthermia.
An event such as this one is a tragedy of proportions that are unimaginable outside the family of this girl and our heart and prayers go out to them. Beyond the immediate event, it once again raises the question of the safety of cosmetic surgery and the role of Malignant Hyperthermia, a rare anesthetic complication.
While I would not present myself as an anesthesiologist or an expert on this disorder, I would like to share some information. Malignant Hyperthermia is a rare defect of specific receptors of muscle cells which manifest when exposed to a variety of anesthetic agents. The result is a massive release of calcium which puts the cells into overdrive, using up all of the oxygen and producing large amounts of carbon dioxide. Heart rate and body temperature rise rapidly and unless treated promptly, it is fatal.
Many cases have been successfully treated and the key is early diagnosis.The drug Dantrolene can stop this reaction and is the mainstay of treatment along with treatment of secondary problems, such as excess carbon dioxide, calcium and potassium in the bloodstream.
Malignant Hyperthermia is rare and I have come across statistics ranging from 1 in 5,000 to 1 in 60,000. It does tend to run in families and if suspected the diagnosis can often be made ahead of time with a muscle biopsy. Unfortunately, up to half of the cases reported describe a prior anesthetic with no problems at all and many do not have a family history of this disease
Sadly, it is very unlikely that this patient and her family could have done anything to anticipate this tragedy. However, it does reaffirm the importance of doing your homework. In addition to finding a board certified plastic surgeon, be sure that you will have a board certified anesthesiologist and that your surgery will be performed in either a hospital or a fully accredited outpatient surgery center. None of these precautions will completely immunize you from risk, but it only makes sense to do everything you can to make your surgery as safe as possible.