Table 2 Managing an MH crisis

Stop potent inhalation agents

Turn vaporisers "OFF" and /or activated charcoal filters inserted into the circuit

Do not repeat succinylcholine if it has been previously administered

Increase minute ventilation to lower ETCO₂

Eliminate the inhalational agent

Get help

• Duty anesthestist

• Consultant anesthetist

Prepare and administer dantrolene

• 2.5 mg/kg initial dose

• Every 10–15 min until acidosis, pyrexia, muscle rigidity are resolving

Begin cooling measures if hyperthermic

• Tissue destruction will occur at 41.5 °C

• Use intravenous normal saline at 4 °C.

• Ice Packs to all exposed areas

• More aggressive measures as needed

Stop cooling measures at 38.5 °C

Treat arrhythmias as needed

• Amiodarone is the first choice

• Lignocaine

• Do not use calcium channel blockers

Secure blood gases, electrolytes, creatine kinase, blood and urine for myoglobin

• Coagulation profile check values regularly

• Treat hyperkalemia with hyperventilation, glucose and insulin as needed

•Once crisis is under control, an MH hotline should be contacted for further guidance

Continue dantrolene

• 1 mg/kg every 4–8 h for 24–48 h

•Alternatively and only if recrudescence occurs, dantrolene at 2.5 mg/kg bolus

Ensure urine output of 2 mL/kg/h with

• Mannitol

• Furosemide

• Fluids as needed

Evaluate need for invasive monitoring and continued mechanical ventilation.

Observe patient in Intensive Care Unit

At least 24 h

Refer patient and family for MH Testing

Contracture or DNA testing