Malignant hyperthermia - Protocol

As per MH ANZ guideline

8 defined roles

1. Coordinator
2. Anaesthetist 1 for resuscitation
3. Anaesthetist 2 for lines and Ix
4. Anaesthetic assistant
5. Dantrolene reconstitution
6. Cooling
7. Logistics
8. Surgical team

1. Coordinator

• Usually done by anaesthetist 1

2. Anaesthetist 1: Resuscitation

(Dantrolene, Rx of complications, and maintaining GA)

Dantrolene

- See [Malignant Hyperthermia (MH) - Dantrolene]({filename}/Malignant Hyperthermia (MH) - Dantrolene.md)

Maintenance of anaesthesia

Rx of...

• Hyperkalaemia
• Arrhythmia
• Acidosis
• IV fluid and renal protection

Inotropic support if appropriate

3. Anaesthetist 2: Lines and Investigations

(Lines, blood tests, and documentation)

• AL / CVL
• Temperature probe
• Lab tests
• Documentation

4. Anaesthetic assistant

• Collect MH box

• Lines setup

• Assist with dantrolene mixing

• Remove volatile agents from theatre

5. Dantrolene reconstitution

• See Malignant Hyperthermia (MH) - Dantrolene

• Dedicated team to prepare

  • But get other people to help as much as possible
  • As many people as possible

• 20 mg/vial

  • Reconstitute with 60 mL of sterile water

• Will need:

  • 2.5 mg/kg IV
  • UP TO 10 mg/kg
  • e.g. for a 70kg man
    • 175 mg bolus (9 ampoules)
    • Up to 700 mg (35 ampoules)

6. Cooling

• Lower OT temperature to lowest setting
• Get ice
• Cover patient with ice
• Collect defibrillator

NB

• Cease active cooling at 38ºC

7. Logistics

• Get more anaesthetists
• Get more dantrolene from other sites
• Get senior surgeon if required to complete surgery rapidly
• Arrange ICU or transfer
• Assist with dantrolene mixing

8. Surgical team

• Complete or abandon surgery as soon as possible
• Insert IDC
• Expose patient for cooling
• Assist with dantrolene mixing