|
Stop potent inhalation agents
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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
|
