To the Editor
The current ASA standards for temperature monitoring state that “When changes in body temperature are intended, anticipated, or suspected the temperature shall be measured. ” I have recently been apprised of a caw of Malignant Hyperthermia that was noted late in the course of the syndrome. By the time suspicion of MH had be-en raised and temperature monitoring was secured, the rectal temperature was well over 102 ‘ F. Other metabolic changes ensued which eventually lead to the demise of the patient.
I have also been involved in consultations on several legal cases involving Malignant Hyperthermia. In at least one of them, a verdict was rendered against the defendant anesthesiologist in large part because the anesthesiologist failed to continuously monitor the patient’s temperature. Reasons commonly given for not continuously monitoring temperature include lack of availability of equipment, inconvenience of placing temperature probes, and possible patient injury from temperature probe placement. All of these excuses are invalid. Temperature monitoring devices are relatively inexpensive. Probes can be placed in the axilla, in the pharynx or in the esophagus and indicate, at the least, temperature trending.
Another reason for failing to monitor temperature, is that fever is said to be a late sign of Malignant Hyperthermia. Although true in general, in specific cases, temperature elevations may occur early in the course of MH.
Furthermore, temperature monitoring detects hypothermia which may result in patient morbidity, especially in children.
I therefore believe that the Anesthesia Patient Safety Foundation should urge the American Society of Anesthesiologists to change the standards of intraoperative monitoring to include continuous body temperature monitoring for all patients receiving general anesthesia. I contend that body temperature changes can be anticipated in any surgical patient undergoing general anesthesia and should be measured. Medico-legal considerations and quality care demand nothing less.
Henry Rosenberg, M.D., Professor and Chairman, Department of Anesthesiology, Hahneman University. Chairman, Professional Advisory Council of MHAUS.