The closest portion of the nasopharyngeal mucosa to the ICA is within the upper or mid-nasopharynx. The depth from the nares to the upper one-third of the nasopharynx is approximately 10 cm. Less than half of nasopharyngeal temperature probes placed blindly by practitioners were optimally positioned.
most recent cohort were lethal. Importantly, and tragically, the risk of death from MH was appreciably higher than in an earlier cohort reported 6 years ago. We must ask ourselves why MH continues to be so lethal when we have a specific antidote and when virtually all anesthesia providers are taught how to diagnose and treat MH.These data convincingly suggest that the answer is our failure to adopt uniform-and appropriate-temperature monitoring standards. This important study showed that 30% of subjects died of an MH episode if their temperatures were not monitored, 21% died if only their skin temperature was monitored, but only 2% (1 subject) died when core temperature was monitored. Perhaps this consistent indifference to temperature is based on the erroneous belief that elevation of temperature is a late sign of MH. This is not the case, and moreover, peak temperature best predicts which patients will die because humans have a critical thermal maximum (between 41.6°C-42°C for 45 minutes to an hour) above which irreversible tissue damage occurs as a result of apoptosis. Excessive body temperature kills. This instructive report also points out that in 23% of all identified cases, the first sign of MH was detected after the surgical procedure was completed, with 8.3% detected in either the postanesthesia unit or intensive care units. Clearly, these findings underscore the need for continued vigilance for MH, including accurate temperature monitoring even after the completion of surgery.To prevent deaths from MH, clinicians should monitor core temperatures whenever their patients undergo general anesthesia for at least 30 minutes. If one monitors core temperature, one detects MH early, one starts treatment earlier, and a life is preserved. Moreover, temperature monitoring is the standard of case not only to prevent/detect hyperthermia. Hypothermia-induced complications are serious and include, but are not limited to, myocardial dysfunction triggered by sympathetic nervous system activation, surgical wound infection, coagulopathy, delayed wound healing, delayed postanesthetic recovery, prolonged hospitalization, shivering, and patient discomfort. Monitoring core temperature requires an electronic temperature probe, which is optimally placed in the upper or mid-nasopharynx. Disposable electronic temperature probes cost $6 each. Who among us wants to have to explain to the next of kin why we chose to save $6? 1 Comment by Kathryn E. McGoldrick, MD, FCAI(Hon) Disclosure: The author declares no conflict of interest.
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