Malignant Hyperthermia
Dantrolene: Mix each 20 mg vial of dantrolene with 60 ml of sterile water! Give 1mg/kg doses up to 10 mg/ kg
Dantrolene 700mg (6 boxes)
Sterile water 60 cc bottles
Hemotap valves (6)
Sodium Bicarbonate 50 meq (6)
Lasix 100mg vials (2)
Lidocaine 1% 50 ml vial (1)
Calcium chloride 1 g vials (4)
Large zip lock bags for Ice (10)
Ng tubes 14 and 18 french
Toomey type 60 cc syringes(for ng irrigation) 2
Esmalol 100 mg vials (2)
Fulminant MH crisis
* Stop triggering agent, (if threre is time and help, remove vaporizer )
* Hyperventilation with 100% O2
* Deepen anesthesia with opioids and sedatives, muscle relaxation with a non depolarizing relaxant
* Check lab (see above), prepare dantrolene perfusion
* Dantrolene 2.5 mg/kg i.v. bolus, repeat bolus until hypermetabolism stops (endexpiratory CO2), give dantrolen 10mg/kg over 24 h continuously
* Sodium bicarbonate according to blood gas analysis or blind (1-2 mval/kg)
* Antiarrhythmic therapy with betablocker (esmolol 0.25 mg/kg i.v.) or lignocaine (1 mg/kg i.v.)
* Stop surgery as soon as possible
* Cooling: for example ice water through a nasogastric tube
* Additional monitoring: arterial catheter, central venous catheter, swan-ganz-catheter, urinary catheter
* Force diuresis
* Postop. ICU
* Check renal function, possible renal failure (myoglobin), coagulation, temperature, electrolytes and creatinkinase
* Inform patient and relatives, test patient and relatives for MH susceptibility in a MH diagnostic center (in vitro contracture test), if positive: MH susceptibility ID card