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Special Services
This section provides information regarding special services provided by the Royal Melbourne Hospital, Melbourne Health.
Services include:
- Allergy testing for suspected reactions to anaesthetic agents (includes form to be completed)
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It should be noted that serum tryptase estimations are now being performed by both the Alfred and Royal Melbourne Hospitals. The test measures total tryptase (that is, alpha pro tryptase and beta tryptase).
A potential problem is that a rise in beta tryptase (associated with anaphylaxis) may be masked if the total tryptase falls within normal levels. There is therefore, a fairly high false negative rate for intra-operative anaphylaxis and a normal total tryptase does not completely exclude anaphylaxis: thus referral for skin testing is still indicated.
The Royal Melbourne Hospital Anaesthetic Department, in conjunction with the Allergy and Clinical Immunology Department has developed a full referral and follow up skin testing service. Patients requiring referral must have complete documentation and the necessary forms can be downloaded from this website. Dr Garry Donnan is the Anaesthetic Specialist involved and his contact details are provided on the form.
Please note The Alfred Hospital also receives referrals for Suspected Anaphylaxis during Anaesthetic & conduct allergy testing.
Suspected Anaphylaxis During Anaesthesia - Report Form
FAX: 9076 2245 Asthma, Allergy & Immunology for referrals - Treatment for Malignant Hyperthermia (Dantrolene)
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Anaesthetists should be aware that between 1987-1999 there were only 5 cases of Malignant Hyperthermia (MH) reported to the Council, all successfully managed. However, there have been several recent reports of suspected MH, including one confirmed fatal case, and a re-evaluation of the provisions for management of this emergency is timely.
It is not the role of this Council to provide management protocols but it should be noted that there is a time critical period for administration of the initial dose of dantrolene of 2.5 mg/kg with subsequent doses up to 10 mg/kg, which also may be time critical, and concomitant cooling is also essential.
It is known that many hospitals maintain a supply of 18 vials of dantrolene and in city areas further supplies should be able to be rapidly obtained. However, in view of the recommendations of the Malignant Hyperthermia Association of the USA that 36 vials should be available in all surgical areas where general anaesthesia is performed, it is suggested that all hospitals, and in particular rural hospitals, should review the ready availability of the drug.
Also, recommended contents of the special MH trolley are:
Equipment
- treatment protocol
- temperature probes
- invasive monitoring catheters
- blood collection tubes for blood gases, electrolytes, platelets and coagulation studies.
Other essential drugs
- 50% dextrose
- antiarrhythmics
- mannitol
- sodium bicarbonate
- frusemide.
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- Information regarding testing for Malignant Hyperthermia (includes form to be completed).
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Dr Robyn Gillies - Head of Malignant Hyperthermia Diagnostic Unit, RMH
10th March 2009Malignant Hyperthermia (MH) testing is currently available in Melbourne.
The Department of Anaesthesia and Pain Management at the Royal Melbourne Hospital coordinates in vitro contracture testing (IVCT) for appropriate patients at risk of Malignant Hyperthermia.
What is the test for MH?
The IVCT is a functional test of live muscle. The dynamic test is performed in the laboratory of the Department of Anaesthesia and Pain Management at the RMH.
The muscle is connected to force transducers to establish degree of contraction when exposed to halothane and caffeine at different concentrations.
All muscle biopsies must take place either at the Royal Melbourne Hospital (RMH) or the Melbourne Private Hospital. In some circumstances by prior arrangement, biopsies can be done at the Royal Children’s Hospital or hospitals located close to the RMH.
Specimens from other hospitals are not appropriate for IVCT as the time between harvest and IVCT is too long. At least 24 hours notice is required for a biopsy at the RMH, as specialised equipment needs to be set up.
How is the biopsy performed?
Muscle biopsies are performed under non-triggering general anaesthesia or femoral nerve block. They are performed by a small group of general surgeons to maintain consistent quality. A 3-5cm length, 1cm width piece of muscle is removed from the vastus lateralis muscle. In appropriate circumstances a further piece of muscle is sent for histological analysis if Central Core disease is suspected. The procedure is done as a day case. Biopsies are no longer performed under infiltrative local anaesthesia as this goes against the European Protocol for testing.
How do I find a MH result?
The Department of Anaesthesia and Pain Management maintains a confidential database of malignant hyperthermia patients. Information may be obtained by contacting Dr Robyn Gillies. The database extends to patients tested by Dr Denborough and Dr Moulds from 1970 onwards.
Who should be tested?
Patients who have had a suspected episode of MH should have an IVCT to firmly establish the diagnosis. Any relatives of a person who has tested positive for MH should consider themselves to be positive until proven otherwise, as MH is an autosomal dominant inherited condition. It may not be necessary or appropriate to test all family members and that is a matter left to counselling, which is part of the MH service at the RMH.
Patients with other muscle disorders such as Central Core Disease or Inherited muscular dystrophy may be appropriate for testing.
Children need to be of sufficient size to have a 3-5cm length, 1cm width piece of muscle removed from their Vastus Lateralis. It would be unusual for the MH unit to biopsy anyone under the age of 12.
How do I organise Testing?
Any enquiries about MH testing should be addressed to Dr Robyn Gillies, staff anaesthetist and coordinator of the MH testing and research unit. If Dr Gillies is absent from the Department, interim enquiries can be directed to Dr Andrew Bjorksten who performs the laboratory test.
What is the availability of genetic testing?
Genetic testing is performed as part of ongoing research into MH at the Royal Melbourne Hospital. It is not yet commercially available in Melbourne.
Contact Numbers:
Dr Robyn Gillies MB BS FANZCA – Staff Anaesthetist
Telephone: (61 3) 9342 7540 or through switchboard (61 3) 9342 7000
Fax: (61 3) 9342 8623
Email: robyn.gillies@mh.org.au
After Hours (urgent enquiries only): 0412 167 707Dr Andrew Bjorksten PhD
Telephone: (61 3) 9342 7920For further information visit the Malignant Hyperthermia Australia & New Zealand website.
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