Clinical signs* |
Hypercarbia (elevated ETCO2) resistant to increases in minute ventilation |
Tachypnea or breathing over the ventilator |
Sinus tachycardia |
Masseter spasm with or without administration of succinylcholine |
Generalized muscle rigidity |
Peaked T waves or other arrhythmia (including PVCs, ventricular tachycardia or fibrillation) as a result of hyperkalemia |
Mixed acidosis on blood gas |
Hyperthermia |
Sweating |
Management |
Call for help and MH cart; for questions at any time call MH hotline: 1-800-644-9737 in US, 1-209-417-3722 outside US |
Discontinue inhaled anesthetics and succinylcholine; increase fresh gas flow to ≥10 L/minute, use non-triggering agents for remainder of procedure |
Notify surgeon; complete surgical procedure as quickly as possible |
Hyperventilate with 100% oxygen, perform endotracheal intubation if ETT not in place |
Insert carbon filters into breathing circuit after flushing the breathing circuit for ≥90 seconds at ≥10 L/minute fresh gas flow |
Administer dantrolene: |
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Send laboratory studies: venous or arterial blood gases, electrolytes, CK; repeat as necessary |
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Repeat after five minutes if ECG changes persist |
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Treat arrhythmias per ACLS, avoid calcium channel blockers; most arrhythmias respond to correction of hyperkalemia and acidosis |
Cool the patient as necessary: Start cooling for core temperature >39°C, discontinue cooling when temperature decreases to 38°C |
Insert Foley catheter, maintain urine output at 1 to 2 mL/kg/hour with IV fluid and diuretics |
Ongoing care |
Arrange ICU bed for at least 24 hours; monitor for recurrence, rhabdomyolysis, DIC |
After initial MH event is controlled, administer dantrolene 1 mg/kg IV every four to six hours or 0.25 mg/kg/hour for at least 24 hours |
ACLS: advanced cardiac life support; CK: creatine kinase; DIC: disseminated intravascular coagulation; ECG: electrocardiogram; ETCO2: end-tidal carbon dioxide; ETT: endotracheal tube; ICU: intensive care unit; IV: intravenous; MH: malignant hyperthermia; PVCs: premature ventricular contractions.
* The sequence and timing of the clinical manifestations of MH vary from patient to patient, and most patients do not develop all signs of MH.Do you want to add Medilib to your home screen?