Table 3.

Immediate causative and symptomatic treatment of acute malignant hyperthermia crisis

Causative treatment	Symptomatic treatment
Stop trigger agent, disconnect vaporizer	Inform surgeon, aim for termination of surgery as soon as possible
Increase respiratory minute volume 2–4-fold with 100% oxygen at maximum fresh gas flow	Stabilize hemodynamics and start antiarrhythmic therapy if appropriate
Administer dantrolene 2 mg/kg initially	Apply internal and external cooling
Continue anesthesia with nontriggering drugs	Extend hemodynamic monitoring, insert arterial line and central venous line if needed
Repeat dantrolene application until clinically stable (maximum 20 mg/kg)	Treat metabolic acidosis, perform forced diuresis