38yo female for elective TKR.

Background

• Severe CP with spastic paraparesis
• Asthma
• 4WW
• Seizure disorder

Issues

• Cannabinoid use – prescribed
• Family member (1^st cousin) with muscle biopsy-proven MH

 Discussion

• How was her cannabinoid use managed perioperatively?
  • In collaboration with the hospital pharmacists, local guidance for adults is to:
    • Confirm suitability of use (i.e., for a condition with recognised benefit)
    • Confirm it is a prescribed, pharmacy-supplied cannabinoid.
    • Where possible, cease use 7d preoperatively
    • The product may be prescribed in hospital if the correct procedure is followed (see attached factsheet) and must be stored in the S8 cupboard.
    • Pharmacy would appreciate a proactive preoperative approach. https://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0011/386516/Continuation_of_cannabinoid_IPU_form_v.1.pdf

• MH family hx, how to proceed?
  • This patient had had previous surgeries using volatile anaesthetic with no issues, making her very low risk
  • Given this is a procedure normally undertaken under SAB and sedation, easy to provide a trigger-free anaesthetic
  • Should we do a muscle Bx on this patient while she’s under anaesthetic?
    • Dedicated team normally reviews each case individually and formulates a plan (if indicated) for investigation. Takes time to organise.
    • If the genetic variant affecting the patient is known, then the other family members can have genetic testing alone.

Plan

• Proceed to OT.
• Cannabinoids to be prescribed in hospital through the appropriate pathway.
• Trigger-free anaesthetic.