Table 2.

Managing an MH crisis

Action	Notes
Stop potent inhalation agents	Turn vaporisers "OFF" and /or activated charcoal filters inserted into the circuit
Do not repeat succinylcholine if it has been previously administered
Increase minute ventilation to lower ETCO2	Eliminate the inhalational agent
Get help	• Duty anesthestist
	• Consultant anesthetist
Prepare and administer dantrolene	• 2.5 mg/kg initial dose
	• Every 10–15 min until acidosis, pyrexia, muscle rigidity are resolving
Begin cooling measures if hyperthermic	• Tissue destruction will occur at 41.5 °C
	• Use intravenous normal saline at 4 °C.
	• Ice Packs to all exposed areas
	• More aggressive measures as needed
Stop cooling measures at 38.5 °C
Treat arrhythmias as needed	• Amiodarone is the first choice
	• Lignocaine
	• Do not use calcium channel blockers
Secure blood gases, electrolytes, creatine kinase, blood and urine for myoglobin	• Coagulation profile check values regularly
	• Treat hyperkalemia with hyperventilation, glucose and insulin as needed
	• Once crisis is under control, an MH hotline should be contacted for further guidance
Continue dantrolene	• 1 mg/kg every 4–8 h for 24–48 h
	• Alternatively and only if recrudescence occurs, dantrolene at 2.5 mg/kg bolus
Ensure urine output of 2 mL/kg/h with	• Mannitol
	• Furosemide
	• Fluids as needed
Evaluate need for invasive monitoring and continued mechanical ventilation.
Observe patient in Intensive Care Unit	At least 24 h
Refer patient and family for MH Testing	Contracture or DNA testing