title: Local anesthesia and malignant hyperthermia: review of the literature and recommendations for the dermatologic surgeon.
abstract: BACKGROUND
  Malignant hyperthermia (MH) is a rare syndrome that is a major cause of anesthetic-related morbidity and mortality in otherwise well patients. The role of local anesthetics, stress, and epinephrine in inducing this syndrome has been subjected to controversy.
  
  
  OBJECTIVE
  To examine the role of local anesthetics, stress, and epinephrine in producing clinically relevant adverse effects in patients with MH.
  
  
  METHODS
  A critical review of the literature.
  
  
  RESULTS
  Local anesthesia is safe for use in usual doses in MH-susceptible patients. The role of stress and epinephrine in precipitating episodes of MH is likely minimal, but controversy remains in the anesthesia and dental literature.
  
  
  CONCLUSIONS
  Recommendations for diagnosis, treatment, and safety precautions to be taken by dermatologic surgeons when treating MH patients are made.
authors.affiliation: Division of Dermatology, University of Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Murray
authors.forename: S S
authors.initials: SS
authors.lastname: Sasaki
authors.forename: D
authors.initials: D
authors.lastname: Berg
mesh_terms: D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000009:adverse effects; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008305:Malignant Hyperthermia / Q000209:etiology*; D012307:Risk Factors; D012871:Skin Diseases / Q000601:surgery*; D013312:Stress, Physiological / Q000150:complications
chemical_list: D000779:Anesthetics, Local; D004837:Epinephrine