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Malignant Hyperthermia - 7
Treatment
Prevention if possible:
Management of an intraoperative episode of MH
- discontinue triggers and
- hyperventilate with 100% O2 and
- call for help
- mix and administer
dantrolene (Dantrium) 3 mg/kg IV, then 1 mg/kg IV Q10 minutes to effect (resolution of acidosis) and continue for 24 to 72 hours. Dantrolene should be dissolved in
sterile water (60 ml water plus 20 mg dantrolene - takes 5-10 minutes to dissolve). Each vial of Dantrium also contains 3 Gm mannitol. Dantrolene has a T1/2 of approximately 6 to 9 hours.
It causes no acute serious toxicity other than muscle weakness, although chronic use for months may result in hepatotoxicity. (Dantrolene has a nonspecific, nondiagnostic antipyretic effect.)
- cool the patient if necessary
- plastic sheet filled with ice water
- iced normal saline in body orifices, cavities and IV
- consider: A-line, CVP line, Foley, PAC
- consider: blood for CPK, K, lactate, blood gases
- arrhythmias:
- treat hyperkalemia
- treat acidosis
- procainamide 15 mg/kg IV slow over 10 minutes
- lidocaine OK
- NOT calcium channel blockers (verapamil + dantrolene has been reported to cause severe hyperkalemia and myocardial depression)
(Durbin and Saltzman).
- consider: sodium bicarbonate, furosemide, insulin + glucose
- consider: call MH Hotline: 1-800-MH-HYPER (1-800-644-9737) (outside U.S. call: 0011-315-428-7924)
Postoperative management
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