| Early Signs: | Suggested Rx | ||||
|---|---|---|---|---|---|
| Tachycardia (sudden,unexplained) | 1. Stop anesthesia and surgery stat. | ||||
| Tachypnea,spontaneous ventilation | 2. Hyperventilate with 100% oxygen | ||||
| Unstable blood pressure | 3. ASAP, administer: dantrolene sodium IV (starting dose of 1mg/kg/max dose:10 mg/kg | ||||
| Dark blood in surgical field | 4. Initiate cooling: a) IV iced NS solution (not Ringers lactate):15 ml/kg/10 min. for 30 min. b) Surface cooling with ice and K-thermia blanket. c) Lavage of stomach, bladder, rectum, peritoneal and thoracic cavities with iced NS. d) If necessary, extracorporeal circulation and heat exchanger. | ||||
| Cyanotic mottling of skin | 5. Correct acidosis and hyperkalemia (1-2 mEq/kg sodium bicarbonate stat guided by pH and PaCO2.) | ||||
| Profuse sweating | 6. Secure major monitoring lines: EKG, temperature, foley catheter, arterial line, CVP, Monitor: PaO2,PaCO2, ECG, pulse, BP, arterial blood gases, CVP, electrolytes (K, Na.) | ||||
| Rapid rise in temperature (1 d. F/15/min) | 7. Maintain urine output of at least 2m./kg/hr: administer mannitol 0.125 g./kg IV and Lasix 1.0 mg/kg IV 9up to 4 doses each.) | ||||
| Fasciculations and/or rigidity | 8. If desirable, administer 0.2 units/kg of insulin in 50% D5W (1 m./kg) as an IV bolus to provide energy to cells. | ||||
| Trismus is an early sign | Monitor patient until danger of subsequent episodes is past. | ||||
| Discolored urine | Post crisis follow-up therapy: | ||||
| Central venous desaturation | Administer oral dantrolene sodium 1-2 mg/kg qid (for 1 to 3 days.) | ||||
| Metabolic acidosis | |||||
| Respiratory acidosis | |||||
| Hyperkalemia | |||||
| Myoglobinuria/myoglobinemia | |||||
| Elevated CPK (late) | MH HOTLINE: (209)634-4917 For the name and phone number of the MH consultant physician on call, dial the MH hotline number and ask for "index zero." MALIGNANT HYPERTHERMIA ASSOCIATION OF THE UNITED STATES | ||||
