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Malignant Hyperthermia (Management (Follow up (Documentation, Patient and…
Malignant Hyperthermia
Management
Declare emergency
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Call for help, MH box and Dantrolene
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Active cooling to 38
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Lavage stomach, bladder, rectum
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Monitoring
Large bore IV, ART, CVC, temp, serial bloods (ABG + full screen)
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Dantrolene
Pharmaceutics
Orange powder containing 20mg Dantrolene and 3g Mannitol. Difficult to mix. 2.5mg/kg IV to max 10mg/kg
Pharmacokinetics
30% bioavail PO, metab by liver enzymes, renally cleared (elim t1/2 10 hours)
Pharmacodynamics
Inhibits Ca release through Ryanodine receptor from SR - prevents excitation/contraction coupling. Not 100% effective (must stop triggers). Can cause phlebitis, extravasation, osmotic diuresis, weakness. Use of Verapamil contraindicated (may cause hyperkalaemia and VF)
MHANZ recommendation
Minimum 24 vials in any anaes location - gives 2-3 doses for average adult (minimum 36 vials in remote location)
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