Materiały źródłowe

• #1 Malignant Hyperthermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430828/

  Malignant hyperthermia (MH) is a hereditary disorder of skeletal muscle that classically presents as a hypermetabolic response to halogenated anesthetic gasses and/or the depolarizing muscle relaxant succinylcholine. […] The critical element in the treatment of malignant hyperthermia is immediate dantrolene administration. Once a malignant hyperthermia episode is suspected, all triggering agents must be discontinued and the patient hyperventilated with 100% oxygen with non-triggering anesthetic agents utilized for patient care, and surgery should be ended as soon as possible. Dantrolene in a dose of 2.5 mg/kg must be administered intravenously as soon as possible, up to a maximum dose of 10mg/kg until the reaction subsides. […] Better patient outcomes are associated with the rapidity of diagnosis, rapid treatment with dantrolene, and prevention of the rapid rise in core temperature by using cooling measures.

• #1 Malignant Hyperthermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430828/

  After the patient has been stabilized, they must be taken to the intensive care unit for at least 24 hours for monitoring and to watch for signs of recrudescence. Patients at the highest risk for recrudescence are those with a large muscle mass or who have undergone at least 150 minutes of anesthetic exposure before triggering. […] All facilities where malignant hyperthermia triggering anesthetics are administered are recommended to stock an adequate amount of dantrolene and other medications and rescue equipment needed to treat a malignant hyperthermia crisis. […] Malignant hyperthermia is a rare, life-threatening disorder. Because of the high morbidity, the disorder is best managed by an interprofessional healthcare team that includes a neurologist, intensivist, anesthesiologist, an internist, nursing staff, and a pharmacist. This interprofessional/collaborative approach will improve patient outcomes.

• #2 Treatment and nursing care of a patient diagnosed with malignant hyperthermia after general anesthesia: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11193925/

  Malignant hyperthermia (MH), characterized by severe myoclonus, pyrexia, tachycardia, hypertension, elevated muscle enzymes, and hypercapnia, often occurs in patients with congenital deformities or genetic disorders. […] Successful treatment of patients with MH largely depends on early diagnosis and timely effective treatment. […] This case is expected to serve as a reference for future interventions and healthcare practices in managing other patients with MH. […] To ensure timely and effective implementation of MH management, healthcare professionals should receive training on MH-related knowledge and engage in clinical simulation exercises that cover early identification of MH as well as the use of dantrolene sodium, cooling measures, and necessary supportive care. […] For patients diagnosed with MH, appropriate management during the post-resuscitation period is particularly important.

• #2 Treatment and nursing care of a patient diagnosed with malignant hyperthermia after general anesthesia: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11193925/

  The following emergency principles after the occurrence of MH should be followed: prompt detection, accurate assessment, elimination of triggers, timely and comprehensive symptomatic treatment, and prevention of complications. […] Once MH has been confirmed, intravenous administration of dantrolene sodium and implementation of effective physical cooling measures are among the methods used for successful management. […] Our patient was successfully rescued after general anesthesia and smoothly recovered during the postoperative period. This outcome indicates the crucial role played by intraoperative monitoring, early diagnosis, effective treatment, and postoperative surveillance. […] Prioritizing preoperative consultations and reinforcing perioperative monitoring are imperative for high-risk populations. […] In addition, it is essential to establish and improve department-specific rescue protocols as pivotal factors in early detection, prompt diagnosis, and effective management, all of which are key factors in improving the success rate of MH treatment and nursing care.

• #3

• #4 Nursing Guide to Malignant Hyperthermia – Straight A Nursing

  https://straightanursingstudent.com/malignant-hyperthermia/

  Malignant hyperthermia is a hypermetabolic crisis that is fatal if left untreated. It occurs in individuals with a specific genetic condition when they are exposed to certain anesthetic gasses or the medication succinylcholine. […] While in this hypermetabolic state, the body generates more heat than it is able to dissipate. This leads to hyperthermia which can occur early or later as the condition progresses. […] Hyperthermia leads to DIC, which causes widespread coagulopathy and, ultimately, hemorrhage. If the patient gets to this point, the outcome is dire and the patient will not survive. […] While under the effects of anesthesia, either during surgery or in the immediate post-op period, the patient is not going to be able to communicate that something is wrong. It is up to you and the other members of the healthcare team (surgeon and anesthesiologist) to notice when something unexpected is happening with the patient. The earliest signs include tachycardia, increased ETCO2 and muscle rigidity.

• #5 Malignant Hyperthermia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17945-malignant-hyperthermia

  Complete recovery from malignant hyperthermia is possible if your anesthesiologist and surgery team recognize the signs and symptoms of malignant hyperthermia early and properly treat it. But multiple organ failure and death can still occur even with prompt treatment. […] If youre going to have surgery, its very important to tell your healthcare providers about any known family medical history related to issues with anesthesia. […] Malignant hyperthermia is a serious and life-threatening reaction to certain anesthesia medications. The good news is that its treatable and even preventable if you know youre at risk for the condition.

• #5 Malignant Hyperthermia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17945-malignant-hyperthermia

  Symptoms of malignant hyperthermia may vary and can happen during your procedure or shortly after surgery while youre recovering. If your symptoms start while youre under the effects of anesthesia asleep or sedated you wont know youre experiencing these symptoms. But your anesthesiologist or nurse anesthetist will. They always carefully monitor people when theyre under anesthesia and will do the same for you. Once they see these signs, theyll respond quickly with treatment for malignant hyperthermia. […] The main treatment for malignant hyperthermia is a drug called dantrolene (Dantrium). […] Anesthesiologists administer this drug immediately if they suspect malignant hyperthermia. They also stop giving the triggering anesthetic, and the surgeon ends the surgery as soon as possible. […] Malignant hyperthermia is difficult to prevent unless you know you have the genetic mutation that causes it or you have a family history of the condition and have told your anesthesiologist. If this is the case, your anesthesiologist wont use the known triggers for your anesthesia plan.

• #6

  https://www.nursingcenter.com/journalarticle?Article_ID=787410&Journal_ID=417221&Issue_ID=787395

  A rare, inherited muscle disorder, malignant hyperthermia can be chemically induced by inhalation anesthetics, such as halothane and enflurane, or muscle relaxants, such as succinylcholine. […] Identification of patients at risk for malignant hyperthermia is key. […] Malignant hyperthermia usually manifests about 10 to 20 minutes after induction of anesthesia, but be aware that it may occur at any time during the first 24 hours after surgery. […] Recognizing symptoms early and discontinuing anesthesia promptly are imperative. […] Goals of treatment are to decrease metabolism, reverse metabolic and respiratory acidosis, correct dysrhythmias, decrease body temperature, provide oxygen and nutrition to tissues, and correct electrolyte imbalance. […] As soon as the diagnosis is made, anesthesia and surgery are halted and the patient is hyperventilated with 100% oxygen. Dantrolene, a skeletal muscle relaxant, and sodium bicarbonate are administered immediately.

• #7 Malignant Hyperthermia (MH) Nursing Interventions | Free NURSING.com Courses

  https://nursing.com/lesson/malignant-hyperthermia-mh-nursing-interventions

  Malignant Hyperthermia (MH) Nursing Interventions […] Guidelines: […] Often fully identified post-op […] Triggers […] Anesthetic gasses (ane) […] Succinylcholine […] Unknown […] Rhabdomyolysis […] Family history, muscle biopsy […] Previous exposure does not guarantee safety […] DANTROLENE […] MH cart […] Cold IVF […] Ryanodex (brand name, $$, important to know which you have) […] Considerations: […] Recognize-act […] Rising-etCO2 […] fighting vent settings […] Tachy […] Acidotic […] Marathon […] Hyperthermia […] could be late […] Rhabdo- late sign […] Rigidity- masseter typically visible […] 1:100,000, 2:1, m:f […] MH chart checks […] Training! […] DIC late sign, with end stage organ fail […] Nurses role: […] Nurses role […] Awareness/identification

• #8 Hyperthermia: case studies and assessment of clinical management

  https://www.myamericannurse.com/malignant-hyperthermia/

  Malignant hyperthermia is a genetic life-threatening disease that results in an uncontrolled release of calcium that causes the body to go into a hypermetabolic state. […] Its triggered by the administration of volatile anesthetic agents or succinylcholine, which is a depolarizing muscle relaxant. […] Signs and symptoms of malignant hyperthermia include tachycardia, increased body temperature, hypercapnia, and muscle breakdown. […] Dantrolene acts on the ryanodine receptor to decrease the release of calcium into the skeleton muscle. […] Andrew suspects malignant hyperthermia (MH) and alerts the team to activate the MH protocol. […] The definitive treatment for MH is dantrolene to inhibit further calcium release. […] The discharge nurse tells Nates family they must alert providers to their sons MH before any procedure that requires anesthesia. […] She also refers them to the Malignant Hyperthermia Association of the United States for information and enrollment in the MH registry.

• #9 02.05 Malignant Hyperthermia | Free NURSING.com Courses

  https://nursing.com/lesson/02-05-malignant-hyperthermia-2

  Malignant hyperthermia (MH) is a rare but life-threatening complication associated with anesthesia drugs, most commonly inhalation anesthetics and succinylcholine. […] Signs and symptoms of malignant hyperthermia include hypercarbia, muscle stiffness, tachypnea, dark blood seen at the operative field, tachycardia, hypoxia, metabolic and respiratory acidosis, cardiac arrhythmias, and an elevation of body temperature, which can rise 1 to 2 Celsius degrees every 5 minutes and is one of the last things to occur. […] If malignant hyperthermia is suspected, the patient can still have surgery, but anesthesia drugs should be adjusted per the anesthesia team. […] Know your facility/anesthesia protocol, including the location and contents of the emergency MH cart, as time is crucial in managing this condition.

• #10 Malignant Hyperthermia (MH) – EMCrit Project

  https://emcrit.org/ibcc/mh/

  Titrate the respiratory rate and tidal volume in order to achieve an end-tidal pCO2 of ~25 mm (~3.3 kPa), if possible. Subsequently, an ABG/VBG may be used to make further adjustments. […] 2.5 mg/kg IV immediately, then administer an additional 1-2.5 mg/kg IV q5min until symptoms subside. […] Continuous monitoring of the core temperature is essential (preferably via a bladder or esophageal temperature probe). […] Initiate cooling if the core temperature is 39C (102.2F), or if the temperature is rapidly rising. […] Treatment involves adequate fluid resuscitation. The initial fluid of choice for resuscitation might be isotonic bicarbonate (D5W with three 50-mEq ampules of bicarbonate per liter), as this may be beneficial for hyperkalemia, acidosis, and rhabdomyolysis. […] Severe MH can cause disseminated intravascular coagulation (DIC).

• #10 Malignant Hyperthermia (MH) – EMCrit Project

  https://emcrit.org/ibcc/mh/

  Malignant hyperthermia (MH) can be caused by any inhalational anesthetic, other than nitrous oxide. MH usually occurs intraoperatively or in the very early postoperative period (up to an hour after finishing anesthesia). […] Treatment must be initiated empirically, when the MH diagnosis is considered probable. The treatments are fairly benign, so it’s generally better to err on the side of treatment. […] Call for an MH cart (if this is available in the operating room). If no MH cart is available, immediately seek help from your pharmacy. You may need: Dantrolene vials (enough to prepare 10 mg/kg at the bedside if needed). Sterile water will be needed to reconstitute the dantrolene. […] Hyperventilate with 100% oxygen at 2-3 times the normal minute ventilation, to clear any residual volatile anesthetic.

• #11 Malignant hyperthermia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/malignant-hyperthermia/diagnosis-treatment/drc-20353752

  Malignant hyperthermia is diagnosed based on signs and symptoms, monitoring during and immediately after anesthesia, and lab tests to identify complications. […] If you or someone in your family has malignant hyperthermia susceptibility (MHS) or you think you may be at risk of malignant hyperthermia, it’s important to tell your health care provider and anesthesiologist before you get anesthesia. Drugs that do not trigger malignant hyperthermia may be used as part of your anesthesia. […] Immediate treatment of malignant hyperthermia includes: […] You may need to stay in the hospital in intensive care for a day or two to monitor your temperature, blood pressure, heart rate, breathing and response to treatment. Several lab tests will be done frequently to check the extent of any muscle breakdown and possible kidney damage. A stay in the hospital is usually needed until lab test results start to return to a standard range.

• #12

  https://journals.lww.com/nursingmanagement/fulltext/2006/07001/malignant_hyperthermia__a_case_study.3.aspx

  Make sure Mr. McMann’s intravenous (I.V.) line is patent, remove the sheets and blankets covering him, and lower the room temperature. Other measures to reduce core body temperature include administering chilled 0.9% sodium chloride solution I.V.; placing ice packs at his groin, axillae, and neck; and applying a temperature-regulating blanket. […] The anesthesia provider arrives and orders I.V. dantrolene, a direct-acting skeletal muscle relaxant and the drug of choice for treating MH. […] Monitor Mr. McMann closely for respiratory depression. […] Obtain blood samples for testing, including arterial blood gas analysis. Monitor for elevated potassium, calcium, magnesium, and creatine kinase levels and assess for signs of respiratory or metabolic acidosis. […] If Mr. McMann develops cardiac arrhythmias, treat them according to advanced cardiac life support guidelines. […] Once Mr. McMann is stabilized, he’s transferred to the intensive care unit. […] Before discharge, teach Mr. McMann about MH and refer him to the Malignant Hyperthermia Association of the United States for more information.

• #12

  https://journals.lww.com/nursingmanagement/fulltext/2006/07001/malignant_hyperthermia__a_case_study.3.aspx

  Mr. McMann’s signs and symptoms make you suspect malignant hyperthermia (MH), a rare but potentially deadly disorder that can be triggered by certain anesthetics (isoflurane, halothane, enflurane, sevoflurane, and desflurane) and the skeletal muscle relaxant succinylcholine. […] Recognizing symptoms early and discontinuing anesthesia promptly are imperative. Goals of treatment are to decrease metabolism, reverse metabolic and respiratory acidosis, correct dysrhythmias, decrease body temperature, provide oxygen and nutrition to tissues, and correct electrolyte imbalance. […] Early diagnosis and treatment of MH are crucial. Administer 100% oxygen via non-rebreather mask and stay with the patient to continue assessing his cardiac rhythm and vital signs. Notify the anesthesia provider and call for the MH cart.

• #13

  https://www.nursingcenter.com/cearticle?an=01261775-202104000-00003&Journal_ID=646631&Issue_ID=5834787

  Patients who have experienced an MH crisis should be monitored closely. Initial laboratory test results that should be obtained includ blood gases, lactate, potassium, and creatine kinase. […] The MH is a rare but potentially fatal condition that requires prompt pharmacologic intervention. Dantrolene has been shown to significantly decrease mortality rates when treating MH and should be administered immediately following identification of an MH response.

• #14 Malignant Hyperthermia Treatment & Management: Dantrolene and Supportive Care, Cancellation or Modification of Surgical Procedure

  https://emedicine.medscape.com/article/2231150-treatment

  Dantrolene and Supportive Care […] Indications for treatment of malignant hyperthermia (MH) with dantrolene include signs of hypermetabolism, a rapid rise in carbon dioxide in the face of an increase in the minute ventilation, tachycardia, muscle and or jaw rigidity (after succinylcholine), and fever (a late sign). […] If an acute MH reaction appears likely, it is best to start giving dantrolene and other recommended treatment modalities promptly rather than wait too long and have a bad outcome. The longer the wait before initiation of therapy, the lower the likelihood of a complete recovery. […] A fulminant, rapidly progressive MH reaction requires early diagnosis and early rapid administration of dantrolene, discontinuance of triggering agents, and assistance from extra personnel. […] Cooling and early treatment of hyperkalemia are desirable. […] An MH tote or cart containing dantrolene and the necessary supplies should be readily available to help reverse the process more quickly. […] Dantrolene is a hydantoin derivative that directly interferes with muscle contraction by inhibiting calcium ion release from the sarcoplasmic reticulum, possibly by binding to ryanodine receptor type 1 (RYR-1). […] Once the initial reaction is controlled, continued monitoring in the intensive care unit (ICU) for 24-48 hours is recommended, along with administration of dantrolene (1 mg/kg q4-6 hr, or an equivalent amount given as a continuous infusion). […] The patient and the family members will need to be educated about MH and should be referred to a testing center for a caffeine halothane contracture test (CHCT).

• #14 Malignant Hyperthermia Treatment & Management: Dantrolene and Supportive Care, Cancellation or Modification of Surgical Procedure

  https://emedicine.medscape.com/article/2231150-treatment

  Cancellation or Modification of Surgical Procedure […] When the anesthesia provider first suspects that an MH reaction may be occurring, the surgeon should be notified promptly, and a decision should be made about whether the procedure is to be continued or canceled. […] If the procedure is to be performed, the following considerations should be kept in mind in planning anesthesia for an MH-susceptible patient: Avoid triggering agents (eg, major inhalational agents and succinylcholine). […] Use nontriggering general, regional, spinal, epidural, or local anesthesia or monitored anesthesia care (MAC). […] Watch for signs of MH. […] Use a clean anesthesia machine; remove vaporizers or tape them in the off position, change soda lime and barium hydroxide lime, replace the circuits, replace the fresh gas tubing if possible, and run oxygen through the machine at 10 L/min for 20 minutes (10 minutes if the fresh gas tubing was replaced).

• #15 Malignant Hyperthermia – Together by St. Jude™

  https://together.stjude.org/en-us/treatment-tests-procedures/symptoms-side-effects/malignant-hyperthermia.html

  Malignant hyperthermia (MH) is a serious reaction to certain anesthesia medicines and another medicine called succinylcholine. […] MH can be fatal if treatment is delayed. But with prompt treatment, survival rates are usually above 90%. […] Before your child has surgery, your health care team will ask whether anyone in the family has had severe reactions to anesthesia. This information will help the doctor choose the best anesthesia for your child. […] A genetic test can show if your child has a gene change that puts them at risk of reacting to some anesthesia medicines. […] If your child has MH, your care team uses treatments such as: Dantrolene, a medicine to relax your child’s muscles, Ice packs to cool the body, IV fluids (given by vein), Sedation, Other supportive care. […] Let your doctors know if genetic tests have shown that your child is at increased risk for MH.

• #16 Nursing Guide to Malignant Hyperthermia – Straight A Nursing

  https://straightanursingstudent.com/malignant-hyperthermia/

  The only antidote for malignant hyperthermia is the medication dantrolene, which is a skeletal muscle relaxant that stops the sustained contraction and prevents the hypermetabolic processes associated with the condition. […] Other key interventions for malignant hyperthermia include: Immediate cessation of the triggering agent as applicable. […] Cool the patient with chilled IV fluids, ice packs (at the groin, axilla and neck), cold saline lavage (if body cavities are open during surgery), and cooling blankets. […] Oxygenation and ventilation support involves hyperventilating the patient with 100% FiO2 to flush out any volatile anesthetics and reduce end tidal CO2. […] Treat hyperkalemia as needed. […] Treat metabolic acidosis as needed. […] Treat cardiac arrhythmias as needed, though the evidence shows that correction of acidosis, hyperkalemia and hyperthermia reduces arrhythmias.

• #17 Malignant Hyperthermia: An Overview

  https://www.uspharmacist.com/article/malignant-hyperthermia-an-overview

  Malignant hyperthermia must be treated rapidly in order to avoid a fatal outcome. […] Healthcare facilities that use known triggering agents must be fully prepared to treat it. […] Indications for treatment of MH include signs of hypermetabolism, rapid increase in carbon dioxide (metabolic acidosis may be delayed), tachycardia, and muscle or jaw rigidity. […] Patients may not present with all of these clinical signs, but without a persuasive alternative diagnosis, it is recommended that dantrolene be initiated and triggering agents be discontinued immediately rather than waiting too long to do so, which could lead to a negative outcome. […] According to the MHAUS, these four things should be done as soon as possible in treating an acute MH event: 1. Notify the surgeon to terminate the procedure as soon as feasible and discontinue volatile agents and succinylcholine. 2. Obtain the dantrolene/MH cart; if at a surgical center rather than a hospital, call 911. 3. Hyperventilate the patient with 100% oxygen at 10 L/minute. 4. Administer dantrolene.

• #17 Malignant Hyperthermia: An Overview

  https://www.uspharmacist.com/article/malignant-hyperthermia-an-overview

  It is recommended that blood gases be tested to determine the degree of metabolic acidosis, and the provider should consider administering sodium bicarbonate at a dosage of 1 to 2 mEq/kg for a base excess greater than 8, for a maximum dosage of 50 mEq. […] Once the initial MH reaction is under control and the patient is stable, the patient should be continuously monitored in a post anesthesia care unit or ICU for at least 24 hours. […] It is important that hospitals respond appropriately to cases of MH. […] The MHAUS recommends that dantrolene be accessible within 10 minutes after the decision to treat is made and that at least 700 mg enough to treat a 70-kg patient be available; this equates to 35 20-mg vials or three 250-mg vials. […] It is imperative that staff who will respond to an MH reaction be familiar with the MHAUS website and its contents to ensure that their team is properly trained and their facility has the recommended treatment modalities readily available in order to achieve the best possible outcome.

• #18 What evidence-based interventions are recommended to alleviate hyperthermia associated with Malignant Hyperthermia? – MHAUS

  https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/what-evidence-based-interventions-are-recommended-to-alleviate-hyperthermia-associated-with-malignant-hyperthermia/

  What evidence-based interventions are recommended to alleviate hyperthermia associated with Malignant Hyperthermia? […] The most important treatment of Malignant Hyperthermia (MH) is discontinuing MH triggering agents, hyperventilation, and timely administration of dantrolene. However, prolonged hyperthermia worsens patients’ outcomes and should also be treated when occurs. […] Many experts believe that hyperthermia is a sign of inadequate physiological treatment and clinicians’ priority should be to stop MH with dantrolene and adequately treat hypercarbia and acidosis before focusing time and efforts on thermal management. […] Thermal management can be divided into three categories: pharmacologic, noninvasive, and invasive. […] Pharmacologic treatment of hyperthermia includes dantrolene, acetaminophen, and nonsteroidal anti-inflammatory drugs. Dantrolene is the only clinically available specific treatment for MH and, after discontinuation of triggering agents, should always be the initial treatment for any suspected MH episode.

• #18 What evidence-based interventions are recommended to alleviate hyperthermia associated with Malignant Hyperthermia? – MHAUS

  https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/what-evidence-based-interventions-are-recommended-to-alleviate-hyperthermia-associated-with-malignant-hyperthermia/

  Noninvasive treatments of hyperthermia include strategic ice packing, forced air cooling, circulating cool water blankets, cold intravenous fluids, and ice-water immersion. […] External cooling methods such as circulating-water mattresses or ice packs should be considered first. If external cooling is insufficient, an easy, effective, and safe next cooling strategy is to infuse 20 mL/kg of refrigerated intravenous fluid. […] Peritoneal lavage is probably the safest and most effective of the invasive approaches if the peritoneum is already open or the patient is in an emergency department with the requisite equipment and skills.

• #19 Malignant Hyperthermia

  https://www.anesthesiaconsiderations.com/malignant-hyperthermia

  Malignant Hyperthermia (MH) […] Management […] Alert surgeon call for help […] Stop anesthetic triggers (volatiles succinylcholine), fresh gas flow to 10L/min; do not change machine or circuit […] If available, insert activated charcoal filters into the inspiratory expiratory limbs of the breathing circuit […] Halt surgery; if emergent, continue with non-triggering anesthetic […] Call MH hotline: […] Assign several people to prepare dantrolene 2.5 mg/kg IV bolus: […] Dilute each 20 mg dantrolene vial in 60 mL preservative-free sterile water […] For 70 kg person, give 175 mg (prepare 9 vials of 20 mg dantrolene) […] Rapidly administer dantrolene continue giving until patient stable […] May need 10 mg/kg […] Cool patient: IV fluids, ice packs, gastric / peritoneal lavage

• #19 Malignant Hyperthermia

  https://www.anesthesiaconsiderations.com/malignant-hyperthermia

  Treat arrhythmias: […] Usually secondary to hyperkalemia […] Treat in standard fashion, however avoid calcium channel blockers […] Treat metabolic acidosis: […] Sodium bicarbonate 1 to 2mEq/kg PRN for base excess greater than -8 […] Treat hyperkalemia: […] Hyperventilation […] Calcium chloride 10mg/kg (max dose 2g) or calcium gluconate 30mg/kg (max 3g) […] D50 1 amp IV (25g dextrose) + regular insulin 10 units IV monitor glucose […] Sodium bicarbonate 1 amp […] Furosemide 0.5-1mg/kg once […] For refractory hyperkalemia, consider beta-agonist, kayexalate, dialysis, or ECMO if in cardiac arrest […] Monitor temperature, electrolytes, arterial/venous blood gases, creatine kinase, urine output, coagulation studies, lactic acid […] Place foley catheter, monitor urine output […] When stable, transfer to post anesthesia care unit or intensive care unit for at least 24 hours […] Monitor for recurrence continue dantrolene 1 mg/kg q 4-6 hours x 24 to 48 hours […] Refer for genetic counseling/in-vitro muscle contracture testing.

• #20 Relaxo | 25 mg | Capsule | রিলাক্সো ২৫ মি.গ্রা. ক্যাপসুল | Ziska Pharmaceuticals Ltd. | Indications, Pharmacology, Dosage, Side Effects and more | MedEx

  https://medex.com.bd/brands/16385/relaxo-25-mg-capsule

  In Malignant Hyperthermia: Oral Relaxo is also indicated preoperatively to prevent or attenuate the development of signs of malignant hyperthermia in known, or strongly suspect, malignant hyperthermia susceptible patients who require anesthesia and/or surgery. Oral Relaxo should be administered following a malignant hyperthermic crisis to prevent recurrence of the signs of malignant hyperthermia. […] For Malignant Hyperthermia: Preoperatively: Administer 4 to 8 mg/kg/day of oral Dantrolene in 3 or 4 divided doses for one or two days prior to surgery, with the last dose being given approximately 3 to 4 hours before scheduled surgery with a minimum of water. […] Post Crisis Follow-up: Oral Dantrolene should also be administered following a malignant hyperthermia crisis, in doses of 4 to 8 mg/kg per day in four divided doses, for a one to three day period to prevent recurrence of the manifestations of malignant hyperthermia.

• #21 Hyperthermia Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/hyperthermia-nursing-diagnosis-care-plan/

  Provide urgent treatment. Cessation of the anesthetic agent, intravenous administration of dantrolene sodium, stat, along with antiarrhythmics, and continued support of the cardiovascular system. […] Institute measures to decrease temperature. The nurse may put the patient into a cool environment, remove excess clothing, and have the patient drink fluids. Initiate emergency transport. Malignant hyperthermia is an acute and possibly life-threatening situation. Ice packs, cooling blankets or cooled IV fluids may also be used to lower the body temperature. […] Educate the family about malignant hyperthermia. People at the highest risk of malignant hyperthermia have an inherited genetic mutation. Obtaining a family history of adverse experiences with anesthesia is essential in identifying patients at risk for malignant hyperthermia.

• #21 Hyperthermia Nursing Diagnosis & Care Plans | NurseTogether

  https://www.nursetogether.com/hyperthermia-nursing-diagnosis-care-plan/

  Malignant hyperthermia is a medical emergency that occurs from a severe reaction to anesthesia drugs. It can occur during surgery or hours after and must be treated promptly with rapid cooling. Signs include a dangerously high body temperature, muscle rigidity, rapid, shallow breathing, rapid heart rate, and abnormal heart rhythms. […] Promptly treat malignant hyperthermia. Dantrolene is the drug of choice in reversing the effects of MH. Rapid cooling measures should also be implemented such as surface cooling methods and infusing cooled IV fluids. […] Hyperthermia related to malignant hyperthermia secondary to anesthesia, as evidenced by decreased urine output and nausea. […] Monitor temperature every hour and more frequently as indicated. Malignant hyperthermia is a life-threatening crisis that requires accurate temperature measurement.

• #22 Nursing Guide to Malignant Hyperthermia – Straight A Nursing

  https://straightanursingstudent.com/malignant-hyperthermia/

  Treat rhabdomyolysis, myoglobinuria, and oliguria as needed. […] Again, it is vital that once the signs of malignant hyperthermia are recognized that additional resources be utilized and prompt intervention initiated. […] Evaluating a patient with malignant hyperthermia involves monitoring for a reduction in symptoms and normalization of body systems. Some goals of care include normothermia, absence of muscle rigidity, regular heart rate and rhythm, absence of hyperkalemia, normalized pH, adequate urine output, absence of myoglobin in the urine, and no signs of bleeding (or any other complication). […] The most important education component for a patient with malignant hyperthermia susceptibility is that they must always share this information with any surgeon and anesthesiologist so that the proper anesthetic agents can be chosen.

• #23 ‘It’s Getting Hot in Here’: A Discussion on Malignant Hyperthermia – AACN

  https://www.aacn.org/blog/its-getting-hot-in-here-a-discussion-on-malignant-hyperthermia

  Malignant hyperthermia (MH) is a rare but life-threatening condition triggered by certain medications. […] Identifying MH early is a crucial component of MH management and prevention of complications. Hence, nurses need to be knowledgeable about the signs and symptoms of MH, which include: […] During an MH crisis, the anesthesia or other healthcare provider treats the patient, and the nursing staff assists. […] After the patient experiences an MH crisis, they are transferred to the ICU for close monitoring for at least 24 hours. Post-crisis, the ICU RN will continue administering the MH medication as ordered, according to the manufacturers guidelines. […] When an MH crisis occurs, patient and family education is vital. Before the patients discharge from the hospital, the patient and their family should be informed about the suspected diagnosis of MH. […] Because MH is a crisis, hospitals and nursing staff should be adequately prepared. […] To increase awareness of MH, AST recommends that staff participate in mock MH crisis drills.

• #24 Malignant Hyperthermia Treatment: What Nurses Need to Know

  https://nursingcecentral.com/malignant-hyperthermia-treatment/

  Malignant hyperthermia (MH) is a severe reaction and a dominantly inherited disorder that occurs in response to certain medications used during general anesthesia. […] The nursing staff have many roles in the immediate management of MH. This includes assessing the patient, administering treatments, and monitoring the patient. Nursing staff must perform risk assessments during a preoperative visit or phone call to identify which patients may be at risk for contracting MH. […] If a patient develops an MH episode, nurses may hyperventilate them with 100% oxygen. They can also initiate cooling measures by placing ice packs and hypothermia blankets on the patients body, such as the neck, groin, and underarms if the patients temperature exceeds 39 degrees Celsius. […] Nurses then monitor the patient for signs of muscle weakness, nausea, vomiting, and difficulty breathing, along with their cardiac status as tachyarrhythmias and tachypnea may occur. […] While this emergency care is taking place, preparing for immediate transfer to the nearest emergency department is critical. […] Continuously evaluate the patient for at least 24 hours following the stoppage of signs of MH in case of a relapse. One-fourth of MH events that relapse can be fatal.

• #25

  https://www.aorn.org/outpatient-surgery/article/always-prepared-for-malignant-hyperthermia

  Providers must be ready to act swiftly when MH is in play. […] So how do you make sure your staff is prepared if an MH crisis does occur? In my experience, focusing on two essential measures is key: stocking a dedicated MH cart to be used during a crisis, and instituting realistic training to ensure your staff can act quickly and confidently if a real-life event ever takes place. […] Make sure you have an MH cart that is properly stocked, organized, labeled and conveniently located. […] The first drawer should contain dantrolene, which is the agent that is used to treat MH. […] Your goal is to get this medication to the patient as quickly and as safely as possible before they go into cardiac arrest. […] Therefore, its crucial to avoid a tunnel-vision mindset. […] If an MH event takes place in the OR, the anesthesia provider may be administering the first couple of doses and then call on the circulator and some extra pairs of hands to help out.

• #25

  https://www.aorn.org/outpatient-surgery/article/always-prepared-for-malignant-hyperthermia

  I recommend that routine MH training be conducted every six months or at least on an annual basis. […] These types of training events are vital because they can help weed out any questions and insecurities your team may have. […] Every second counts during an MH event, so even something as simple as making sure your team knows where the MH cart is located can make all the difference.

• #26 Malignant hyperthermia | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/malignant-hyperthermia

  You may need to stay in the hospital in intensive care for a day or two to monitor your temperature, blood pressure, heart rate, breathing and response to treatment. Several lab tests will be done frequently to check the extent of any muscle breakdown and possible kidney damage. A stay in the hospital is usually needed until lab test results start to return to a standard range. […] If you’ve experienced malignant hyperthermia due to certain anesthesia drugs, exercising during excessive heat and humidity could trigger another reaction. Talk to your health care provider about any precautions you should take. […] If you have the genetic disorder MHS that puts you at risk of malignant hyperthermia, wear a medical alert bracelet or necklace. This lets health care providers know of your risk, especially in an emergency, when you may not be able to talk.

• #27 Malignant Hyperthermia | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/condition/m/malignant-hyperthermia

  If you experience a MH crisis, there is treatment available a drug called dantrolene. However, effectiveness is greatest when given early. Dantrolene is given through an intravenous line and is thought to reverse the effects of triggering agents on muscle function. […] If dantrolene is started promptly in a MH crisis, together with rapid cooling, discontinuing triggering agent, and hyperventilating with oxygen, the risk of complications or death is substantially reduced. […] The most important thing is to inform all your health care providers and especially your anesthesiologist if you are going to have any type of surgery. […] Worldwide not a single patient has died from MH when his or her condition was previously known to the medical team and appropriate precautions were taken. […] Yes. If you are MH-susceptible it is strongly advised that you wear an identification bracelet at all times so that any health care professional will be alerted to your condition.

• #27 Malignant Hyperthermia | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/condition/m/malignant-hyperthermia

  Malignant hyperthermia is a rare condition that causes a fast rise in body temperature when someone with the disease receives general anesthesia. […] Malignant hyperthermia (MH) is a rare, inherited condition that causes muscle rigidity, high fever, fast heart rate, and abnormal muscle contractions when someone with the disease receives general anesthesia. […] A MH crisis can occur when a susceptible patient is exposed to triggering agents. […] This exposure can lead to muscle rigidity, very high fever, failure of other organs (kidney, lung), abnormal blood clotting and other life-threatening complications. […] If treatment is not started promptly, up to 7 out of 10 patients may die from a MH crisis and its complications. […] Preventing a MH crisis is the key. If you are MH-susceptible, safe anesthesia agents will be used and the risk of a MH crisis can be avoided.

• #28 Malignant Hyperthermia | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/condition/m/malignant-hyperthermia

  However, if you are undergoing any type of surgical or dental procedure requiring the use of anesthetics, certain precautions need to be taken by your health care provider to avoid complications. Therefore, it is most important to inform your health care provider about your MH-susceptibility. […] Each of his or her children have a 50 percent chance of inheriting this condition. […] The risk of anesthesia complications from MH is the same in pregnant and non-pregnant patients; therefore, the same precautions as in any other MH-susceptible patients must be followed (e.g., in the case of a cesarean section under general anesthesia). […] Wearing an identification bracelet is strongly recommended.

• #29 Malignant hyperthermia: causes & treatment

  https://www.acls.net/malignant-hyperthermia

  Malignant hyperthermia (MH) was first described by Denborough in 1962 when deaths were occurring during and immediately (within 24 hours) following the administration of anesthesia medications. […] Patients at risk for MH are very difficult to screen. […] Although the most common patients are surgical patients, MH has also been reported after anesthesia medications are used for sedation in surgeons offices, intensive care units, dental offices, and emergency departments. […] If appropriately treated, the mortality rate is less than 10%. […] One of the ways that the surgical team can better prepare is by maintaining an emergency cart dedicated to the treatment of malignant hyperthermia. […] Early diagnosis and treatment are essential to limit mortality. […] Dantrolene, a skeletal muscle relaxant specifically developed for the treatment of MH, is the backbone of the treatment regimen. […] To reduce the time needed to implement a definitive treatment, it is recommended that each operating room, outpatient surgery center, and physician office where surgical procedures are performed have a cart dedicated to MH.

• #30 Malignant hyperthermia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/malignant-hyperthermia/symptoms-causes/syc-20353750

  Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia. This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms. Without prompt treatment, the complications caused by malignant hyperthermia can be fatal. […] Treatments for malignant hyperthermia include the medication dantrolene (Dantrium, Revonto, Ryanodex), ice packs and other measures to cool body temperature, as well as supportive care. […] If someone in your family is known to be at risk of malignant hyperthermia and you need to have anesthesia, it’s important to tell your health care provider and anesthesia specialist (anesthesiologist). Other drugs may be used instead. […] Evaluating your risk of malignant hyperthermia allows your anesthesiologist to avoid certain anesthesia drugs.

• #31 SHARE @ Advocate Health – Midwest – Nursing Research & Professional Development Conference: Malignant hyperthermia simulation and competency

  https://institutionalrepository.aah.org/nursing_conference/2023/quality/6/

  Malignant hyperthermia (MH) is a potentially fatal reaction to a volatile anesthetic or succinylcholine producing a hypermetabolic state. Prompt recognition and treatment of MH are essential for survival. […] Rapid Response Team (RRT) leaders identified a nursing knowledge gap about the process for treating MH for patients outside high-risk areas at a level 1 trauma center. […] A new process, workflow, and medication box were created for obtaining the necessary supplies to treat MH patients. RRT nursing leaders developed a simulation education program with the goals to improve overall MH knowledge and to develop RRT nurses response skills for MH management using the new process, workflow, and treatment box. […] The simulation experience helped the RRT nurses gain experience and learn about the process, workflow, and new treatment box for treating MH. The increase in knowledge and skill after 3 months was promising and indicates that the simulation helped RRT nurses retain MH knowledge over time. The new MH process will help decrease the response time from symptom recognition to medication administration. However, due to the low volume of MH cases, this simulation may have to be conducted annually to keep the RRT nurses proficient in the MH process.

• #32 CE Activity | Malignant Hyperthermia | NPs

  https://www.statpearls.com/nursepractitioner/ce/activity/95918

  Malignant hyperthermia (MH) is a hereditary disorder of skeletal muscle that classically presents as a hypermetabolic response to halogenated anesthetic gasses and/or the depolarizing muscle relaxant succinylcholine. […] This activity reviews the evaluation and treatment of malignant hyperthermia and the interprofessional team’s role in evaluating and treating this condition. […] Outline the treatment of malignant hyperthermia. […] Summarize the role of the interprofessional team in the evaluation and treatment of malignant hyperthermia. […] Outline the pharmacologic therapy as it applies to Malignant Hyperthermia.

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