MH Crisis Management

Most senior anaesthetist present should co-ordinate crisis management

If an MH crisis is suspected / confirmed (see below):

  1. Declare Emergency (complete or abandon surgery)
  2. Call for HELP
  3. Send for the MH box and refrigerated supplies
  4. Turn off volatile agent and remove vaporisers from anaesthetic machine
  5. 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