Mh Acute Crisis

MH acute crisis Manifestations : • Hypercarbia, Tachycardia, Tachypnea, Temp ↑ (1°C–2°C increase every 5 minutes), HTN, Cardiac dysrhythmias, Acidosis, Arterial hypoxemia, Hyperkalemia, Skeletal muscle activity, Myoglobinuria • DDx: pheo, thyroid storm, carcinoid Management: • Call for help • Discontinue inhaled anesthetics and succinylcholine • Hyperventilate the lungs with 100% O2 • Administer dantrolene (2.5 mg/kg iv) with repeated doses (up to a maximum of 10 mg/kg iv) based on Paco2, heart rate, and body temperature (each ampule of 20 mg is mixed with 50 ml of distilled water) • If Dantrolene is not available, give procainamide IV 1mg/kg up to 15mg/kg • Treat persistent acidosis with sodium bicarbonate (1–2 mEq/kg iv) • Control body temperature (gastric lavage, external ice packs until 38°C) • Replace anesthetic circuit and canister • Monitor with capnography and arterial blood gases

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Be prepared to treat hyperkalemia and cardiac dysrhythmias Add further monitoring: Art-line, temp prob, CVP, frequent ABG, coags, CK, ALT, AST, LDH, lytes, Foley cath Maintain urine output, 1/ml/kg/h → consider diuretics Once the acute attach is controlled → ICU and watch for late complications: cereberal edema, pul edema, DIC, recurrent of MH, renal failure Continue Dantrolene for post-op IV or orally for 48 hrs