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Post-Crisis Management of MH
If you suspect an MH crisis in a patient under a triggering anesthesia, follow these steps to manage the MH crisis. Click on each step to view detailed information. Caution: This protocol may not apply to every patient and may require modification depending on the specific needs of each patient.
- Observe for at least 24 hours
- Administer dantrolene
- Monitor other variables until normal
- Counsel the patient and family
- Consult further if needed
1. Observe for at least 24 hours
Observe the patient in an Intensive Care Unit setting for at least 24 hours. Recrudescence of an MH reaction may occur and require further therapy.
2. Administer dantrolene
Administer bolus doses of dantrolene 1 mg/kg IV every 6 hours for 24 to 48 hours after the crisis. After that, oral dantrolene 1 mg/kg every 6 hours may be used for 24 hours as necessary.
3. Monitor other variables until normal
Follow and treat every 6 hours, until they return to normal:
- ABG
- serum CK
- potassium
- calcium
- urine and serum myoglobin
- clotting studies
Central temperature (e.g. axillary, rectal, esophageal) should be consciously monitored until stable.
4. Counsel the patient and family
Counsel the patient and family regarding MH and further precautions. MH susceptibility is inherited in an autosomal dominant fashion. For additional information on MH, refer the patient to the Malignant Hyperthermia Unit.
5. Consult further if needed
Further consultation on MH is available at most university-based anesthesia departments, or the nearest clinical unit specializing in malignant hyperthermia.
