Most senior anaesthetist present should co-ordinate crisis management
If an MH crisis is suspected / confirmed (see below):
- Declare Emergency (complete or abandon surgery)
- Call for HELP
- Send for the MH box and refrigerated supplies
- Turn off volatile agent and remove vaporisers from anaesthetic machine
- Hyperventilate with 100% oxygen and high fresh gas flows (>15L/min)
(Do not waste time changing machine or circuit)
Consider intravenous anaesthesia maintenance
Task Cards: The MH box contains individual task cards for MH crisis management:
Give each available staff member a card (or two) and ask them to complete the self-explanatory instructions.
There are multiple high priority tasks, but ……
Dantrolene administration is the priority.
(Assign as many staff as possible to this task.)
How can I tell if it’s really Malignant Hyperthermia?
MH can be difficult to diagnose.
Know who is susceptible:
Malignant Hyperthermia may occur in any patient, including patients who have previously had uneventful general anaesthesia.
MH is more likely with:
Diagnosed malignant hyperthermia susceptibility after halothane / caffeine contracture test on biopsied muscle, Malignant Hyperthermia susceptible relatives, Significantly & consistently raised resting serum CK, Several very rare muscle disorders
Know the signs & symptoms:
Not all need to be present to initiate treatment