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 



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