Quick Reference: Malignant Hyperthermia
Malignant hyperthermia (MH) is triggered by certain types of anesthetic agents, typically succinylcholine, sevoflurane, desflurane, isoflurane and halothane.
The earliest sign and symptom that will present is an increase in end-tidal carbon dioxide. Other additional early signs include tachycardia, tachypnea, and rigidity of the masseter muscle called trismus. As an MH crisis progresses, other signs and symptoms are unstable blood pressure, cyanosis and/or mottling of the skin, diaphoresis, cardiac dysrhythmia and a dramatic increase in the body temperature.
Treatment:
- Stop succinylcholine and inhalation agents.
- Dantrolene 2.5mg/kg by Anesthesia.
- Hyperventilate with 100% oxygen.
- Treat respiratory and metabolic acidosis.
- Institute body cooling measures attempting to bring the body temperature to 38 degrees C.
- Use cold intravenous normal saline, ice packs and cold body lavage (nasogastric/rectal).
- Monitor urine output and attempt to keep the urine output elevated to 2 ml/kg/hr using fluid and diuretics.
- Obtain ABGs, electrolytes, calcium, coagulation studies and creatine phosphokinase (CPK).
- Refrain from using calcium channel blockers.
- Treat hyperkalemia/dysrhythmias.
