FUNCTION:  Operative and Other Invasive Procedures

 

TITLE:  Malignant Hyperthermia

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PURPOSE:

 

To provide an outline of care for treatment of malignant hyperthermia.

 

POLICY:

 

Patients are divided into three (3) categories:

 

     a.   At risk (previous history of the syndrome, family history of the

          syndrome, or sudden death).

     b.   Susceptible patient (generalized muscle bulk, localized muscle

          weakness or cramps, joint hypermobility, ptosis kyphoscoliosis,

          hernias and club feet).

     c.   Any other patient.

 

PROCEDURE:

 

1.   Suggested standard treatment regime:

 

     a.   Stop anesthesia and surgery immediately.  Change rubber goods and

          anesthesia machine.

     b.   Hyperventilate with 99% oxygen (flow 8 - 10 liters).

     c.   As soon as possible, administer Dantrium IV (starting dose of 1mg/kg

          up to total of 10mg/kg by rapid infusion and Procainamide IV

          (15mg/kg over 10 minutes) if required for arrhythmias.

     d.   Initiate cooling:

          1)   IV iced saline solution (not Lactated Ringers), 1000ml/10min. 

               for 30 minutes.

          2)   Surface cooling with ice and hypothermia blanket.

          3)   Lavage of stomach, bladder, rectum, peritoneal and thoracic

               cavities with iced saline (3-6 liters).

          4)   If necessary, extra-corporeal circulation and heat exchanger

               (femoral to femoral).

     e.   Correct acidosis and hyperkalemia (100 mEq sodium bicarbonate STAT

          and up to 600 mEq total, guided by pH and PCO2).

     f.   Secure monitoring lines, ECG, temperature, Foley catheter arterial

          pressure.  Monitor ECG, temperature, urinary output, arterial

          pressure and blood gases (PCO2, PO2), central venous pressure,

          electrolytes (K, Na), pH.

     g.   Maintain urine output of at least 2 ml/hr.  Administer Mannitol

          12.5g IV and furosemide 50mg IV (up to four (4) doses each).

     h.   If desirable, administer ten (10) units insulin 50% D/W (10ml) as an

          IV bolus to provide energy to the cells.

     i.   Monitor patient until danger of subsequent episodes is passed.

     j.   Post-crisis follow-up therapy:  administer oral Dantrium 1.2mg/kg

          q.i.d. (for 1 to 3 days).

 

2.   Medications:

 

     a.   Sodium bicarbonate 8.4%.

     b.   Mannitol 12.5g/50ml x 4.

     c.   Lasix 10mg/ml.

     d.   Calcium gluconate 1g/10ml.

     e.   Glucose 50% x 2.

     f.   Dantroline 6-8mg/kilo body weight (make sure it's not outdated).

     g.   Procainamide x 2 bottles.