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Table 2 Managing an MH crisis

From: Malignant hyperthermia: a review

Action Notes
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