Malignant Hyperthermia Crisis - Guidelines for Crises in Anaesthesia Unexplained increase in ETCO2 AND tachycardia AND increased oxygen requirement. Temperature rise is a late sign. MH is rare. Always consider other, more common causes (see 2-8 Peri-operative hyperthermia). ❶ Call for help and inform theatre team of problem, note the time. ❷ Allocate tasks as scenario develops (see Box A). ❸ Aim to abandon or finish surgery as soon as possible. ❹ Call for MH treatment pack/dantrolene and cardiac arrest trolley. ❺ Remove vaporisers from machine. ❻ Give highest possible fresh gas flow and hyperventilate lungs: • Change breathing system is NOT a priority. ❼ Maintain anaesthesia with intravenous hypnotic agent and muscle relaxation with a nondepolarising neuromuscular blocking agent. ❽ Give dantrolene (see Box B). Delegate mixing – it is time and labour intensive ❾ Begin active cooling: • Reduce the operating room ambient temperature. • Cooling jackets or blankets. • Ice packing in groin, axillae and anterior neck. • Bladder, gastric or peritoneal lavage with boluses 10 ml.kg-1 iced water. ❿ Begin continuous monitoring of: core and peripheral temperature, invasive BP, CVP. ⓫ Send urgent blood samples and repeat as indicated (Box C). ⓬ Treat complications (see Box D). ⓭ Plan admission to critical care. INVESTIGATIONS Arterial blood gases every 30 mins, U&E, CK, FBC, coagulation screen, group and save/cross-match blood as indicated COMPLICATIONS AND OUTLINE TREATMENTS AVOID calcium channel blockers - interaction with dantrolene Hyperkalaemia: calcium chloride, glucose/insulin, bicarbonate Arrhythmias: magnesium/amiodarone/metoprolol Metabolic acidosis: hyperventilate, sodium bicarbonate Myoglobinaemia: forced alkaline diuresis (mannitol/furosemide +bicarbonate); may require renal replacement therapy later DIC: FFP, cryoprecipitate, platelets By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Malignant #Hyperthermia #Crisis #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
