Signs and treatment of MH
Knowing the signs of MH is crucial to effective treatment
![Contact Info](/wp-content/uploads/2021/10/Signs_Treatment_Icon.png)
Signs may arise at any time during anesthesia or the early postoperative period.1
Malignant Hyperthermia Signs2
![Early Metabolic Signs](/wp-content/uploads/2021/10/Early_Metabolic_Signs.png)
Early metabolic signs
- Inappropriately elevated carbon dioxide production
(manifested as raised end-tidal CO2 on capnography or as tachypnea if the patient is breathing spontaneously) - Increased oxygen consumption
- Mixed metabolic and respiratory acidosis
- Profuse sweating
- Mottling of skin
![Early cardiovascular signs](/wp-content/uploads/2021/10/Early_Cardiovascular_Sign.png)
Early cardiovascular signs
- Inappropriate tachycardia
- Cardiac arrhythmia (especially ectopic ventricular beats and ventricular bigemini)
- Unstable arterial pressure
![Muscle Rigidity](/wp-content/uploads/2021/10/Muscle_Rigidity.png)
Muscle rigidity
- Masseter spasm if succinylcholine has been used
- Generalized muscle rigidity
Later signs of MH
- Hyperkalemia
- Rapid increase in core body temperature
- Grossly elevated blood levels of creatine phosphokinase and myoglobin
- Dark urine (myoglobinuria)
- Severe cardiac arrhythmia and cardiac arrest
- Disseminated intravascular coagulation
![Treatment](/wp-content/uploads/2021/10/Vial_and_IV.png)
Treatment should be started as soon as an MH crisis is suspected.2
MH Treatment
Suggested treatment protocol for MH includes
- Immediate discontinuation of all trigger agents
- Administration of nontriggering anesthetic if necessary
- Hyperventilation with 100% oxygen
- Dantrolene sodium, administered by continuous rapid intravenous push
- Cooling procedures until body temperature is <38.5°C
- Dextrose, insulin, calcium chloride, and possibly dialysis for correction of hyperkalemia
- Hyperventilation and possibly sodium bicarbonate for management of acidosis
- Antiarrhythmic drug treatment, if necessary
- Diuretic and fluid therapy to maintain high urinary output