Tuesday, October 26, 2004
Copyright © Las Vegas Review-Journal

Victim of disorder shares warning tale

Usual anesthetics in surgery can cause death

At the American Society of Anesthesiologists convention in Las Vegas, Stephen Martinez, center, on Monday tells anesthesia technicians Chuck Stockard, right, and Sherman Jackson about malignant hyperthermia, a genetic disorder he has that causes a life-threatening reaction to common anesthetics. Photo by Clint Karlsen. Dr. Henry Rosenberg Regulations concern chief of Malignant Hyperthermia Association

When Stephen Martinez went into Sunrise Hospital and Medical Center for groin surgery, he and his parents were told the procedure was so minor he could probably go home the same day.

He almost died.

The medical team did nothing wrong.

The team, led by anesthesiologist Dr. Michael Detmer, did everything right, and that is the reason Martinez shared his story Monday at the American Society of Anesthesiologists national convention, which ends today, at the Las Vegas Convention Center.

"I want to make sure everybody does things right like Dr. Detmer did," Martinez said as he handed out literature about the condition that almost killed him.

Martinez, 20, has a silent genetic disorder, one he did not know about until after doctors saved his life, known as malignant hyperthermia. Only when people who have MH are given a general anesthetic can it turn deadly.

The rate of occurrence has been estimated to be as frequent as one in 5,000 administrations of general anesthesia. Until 1980, MH had a mortality rate of 80 percent. Death can result from cardiac arrest, brain damage, internal hemorrhaging or failure of other body systems.

Now, largely because of the drug dantrolene, which counteracts the disorder, MH episodes resulting in death have been cut to 10 percent.

Most people with the condition are like Martinez: They have no idea they have it until they have a reaction. A DNA test is being developed, but an expensive and painful muscle biopsy is currently the only way to confirm MH.

Of concern to the Malignant Hyperthermia Association of the United States, which Martinez represents, is that many surgeries are being performed in Las Vegas doctors' offices. As such, there are no regulations requiring physicians to have dantrolene or an anesthesiologist, on hand.

The American Medical Association estimates that more than 25 percent of surgeries are done in doctors' offices.

Martinez's father, J.R., knows what would have happened if his son had not undergone surgery at a facility with stiff regulations.

"He wouldn't be here," he said. "I had a feeling something was wrong when we didn't hear from the doctors for about two hours. He was supposed to be done in an hour."

What happened in 1999 with Martinez, then a high school freshman, inside the Sunrise operating room was "more than scary," Detmer said.

"It's the only time in my 25 years of practice that I had such a case," he said.

Even before Martinez' body stiffened and his temperature rose, signs of an MH episode, Detmer realized the patient had indications of MH. The physician had noted the carbon dioxide Martinez was exhaling was far above normal.

"His metabolism was way up," Detmer said. "He was breathing very rapidly."

Detmer announced a MH crisis, and a Sunrise crisis response team arrived, quickly preparing a mixture including dantrolene that he could administer intravenously.

The gas Martinez had received was turned off, and measures were taken to remove it from his system. He was put on anesthesia that does not trigger MH. He left the hospital four days later.

"He's very lucky," Detmer said.

Martinez, who works in the parts department of Fairway Chevrolet, said all anesthesiologists, and anyone administering anesthesia, should go through a certification process for handling MH.

"If you don't recognize it quickly enough, it's all over," Martinez said.

"It doesn't take long before you are at the point of no return," said Dr. Henry Rosenberg, president of the hyperthermia association. "Hospitals and ambulatory care centers are required to have dantrolene on hand. Doctors' offices aren't operating under the same regulations."

Children and siblings of a patient with MH susceptibility have a 50 percent chance of carrying the gene for MH. What makes the condition more difficult to deal with is that an individual with MH can have general anesthesia on a number of occasions before having a reaction.

Martinez subsequently had a biopsy taken from his thigh muscle at UCLA, which confirmed his MH trait, but other members of his family haven't. They assume they have it.

Like Martinez, they are supposed to wear bracelets and carry a card that warns medical officials they have to have special anesthetics.

Martinez can't thank Detmer enough.

"Dr. Detmer even came to my high school graduation," he said. "He's the kind of doctor who stays on top of everything because he cares about his patients."