Definition of mh

-It is characterized by the hypermetabolic response to potent inhalation agents and succinylcholine
resulting in increased co2 production, oxygen consumption, fever, tachycardia, tachypnea, acidosis,
hyperkalemia, myoglobinuria, increased creatine phosphokinase (cpk), cyanosis and death.

SIGN AND SYMPTOMS

 ↑ CO2
 TACHYCARDIA
 TACHYPNOEA
 ARTERIAL HYPOXEMIA
 HYPERCARBIA
 METABOLIC&RESPIRATORY ACIDOSIS
 HYPERKALEMIA
 CARDIAC ARRHYTHMIAS
 HYPERTENSIONON
 SKELETAL MUSCLE RIGIDITY (MASSETER SPASM)
 ↑BODY TEMPERATURE
 ↑CPK

EARLY DIAGNOSTIC SIGNS OF MH

 ↑ CO2
 TACHYCARDIA
 HYPOTENSION, HYPOXEMIA & ACIDOSIS

INVESTIGATIONS

1. CAPNOGRAPH:
-↑ CO2

2.SPO2:
-DESATURATION

3. ECG :
-TACHYCARDIA
-ARRHYTHMIAS
 VF
 VT

4. ABG :
-ARTERIAL HYPOXEMIA
-HYPERCARBIA
-RESPIRATORY& METABOLIC ACIDOSIS

5. ELECTROLYTES :
 -HYPERKALEMIA
-↑TRANSAMINASE ENZYMES
-↑CPK

6.PLASMA & URINE MYOGLOBIN ↑

COMPLICATIONS OF MH
 DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
 PULMONARY EDEMA
 ACUTE RENAL FAILURE
 SEIZURE
 COMA
 PARALYSIS

TREATMENT OF MH

ACUTE PHASE

1. Get help, get dantrolene, and notify the surgeon.

-immediately terminate triggered drugs and conclude surgery as soon as possible. If emergent, use
non-triggers (use ga machine without vaporizers)

-hyperventilate with 100% oxygen

2. Dantrolene 2.5mg/kg rapidly iv

-Repeat until symptoms controlled

-Dissolve in 20mg in each vial with at least 60mls 0f water for injection

3.Bicarbonate for metabolic acidosis

4. Active Cooling

Cold Saline

Gastric Lavage with Iced Saline

Surface Cooling

5. Dysrhythmias

-Use standards drug therapy except for calcium channel blockers

6. Hyperkalaemia

-Bicarbonate 1-2mg/Kg Iv

-For paeds,0.1 units insulin/kg and 1ml/kg 50% glucose or for adults,10 units regular insulin iv and
50ml 50% glucose

-Calcium gluconate 10% 10-50mg/kg -check glucose hourly

7. Monitor
-Co2,Electrolytes,Abg,Ck,Temperature,Urine

-VBG

-Cv Or Pa

-Minute Ventilation

POST-ACUTE PHASE

1. Observe pt in ICU for 36hours

2. Dantrolene 1mg/kg q 4-6hours or 0.25mg/kg/hr infusion
3. Monitor vitals and lab investigation
4. Counsel the pt and family regarding mh