Malignant Hyperthermia
Malignant Hyperthermia
1. Notify Surgeon and OR teams
2. Stop triggers
(inhalation and succinylcholine)
[transition to non-triggering anesthetic]
3. High flow 100% oxygen
[fresh gas flow > 10 liters/min to flush machine]
[Consider changing CO2 absorber]
4. Hyperventilate to blow off excess CO2
5. Call for help
-Get personnel
-Get MH cart
6. Dantrolene 2.5 mg/kg IV: repeat up to 10 mg/kg
-Dantrium© or Revonto©: 20 mg vials with 60 ml sterile water
[over 12 vials of Dantrium© or Revonto© if > 100 kg]
-Ryanodex© 250 mg vial with 5 ml sterile water
[about 1 vial of Ryanodex© if <
100kg]
Call MH hotline: 1-800-644-9737 for redosing guidance:
1 mg/kg dantrolene IV q 4-6 hours
7. Stop procedure ASAP
8. Treat Hyperkalemia
-Calcium Chloride 10 mg/kg IV or Calcium Gluconate 30 mgkg IV
[calcium stabilizes myocardium]
-D50 (1 amp 50 ml- 25 gram) with 10 units regular insulin
[check glucose levels every 60 minutes]
-Hyperventilate
-furosemide 5 to 20 mg IV
9. Cool patient for temp > 38.5C
(target to temp < 38C)
-cooled IV fluids (minimize potassium)
-ice pack groin, axilla and head
-cooling blanket
10. Sodium Bicarbonate
-up to 1 mEq/kg/hour
-shifts potassium intracellularly
-treats metabolic acidosis (target pH > 7.2)
-alkalinizes urine to treat rhabdomyolysis - myoglobinemia
11. Laboratory analysis
-arterial blood gas (and lactate)
-venous blood gas
-electrolytes (potassium)
-serum creatinine kinase (CK)
-urine pH and myoglobin
-coags: PT and PTT, Fibrinogen, Fibrin split products, CBC
12. Treat arrhythmias per ACLS guidelines except:
NO CALCIUM CHANNEL BLOCKERS IN MH-FIRING PATIENTS
13. When stable for transfer--transfer to ICU
bed
-weak from dantrolene and frequently require mechanical ventilation
