Call the MH hotline for additional guidance if needed:.Refrigerated crystalloid, if available.Isotonic bicarbonate (e.g., two liters this is generally formulated by adding three 50-mEq ampules of sodium bicarbonate to each liter of D5W).IV insulin (e.g., 10 units for intravenous administration).IV calcium (e.g., two 1-gram ampules of calcium chloride).Sterile water will be needed to reconstitute the dantrolene. Dantrolene vials (enough to prepare 10 mg/kg at the bedside if needed).If no MH cart is available, immediately seek help from your pharmacy. Call for an MH cart (if this is available in the operating room).The treatments are fairly benign, so it's generally better to err on the side of treatment. Treatment must be initiated empirically, when the MH diagnosis is considered probable. Cola-colored urine may occur, due to rhabdomyolysis.Ventricular tachycardia or ventricular fibrillation due to hyperkalemia.The key initial finding is the rate of temperature rise, which can be as rapid as 1-2 C every five minutes.

Rigidity may occur despite neuromuscular blockade.Especially tends to involve the masseter muscles of the jaw.Muscle rigidity may be an early finding:.The volumetric CO2 should increase substantially in MH, regardless of whether the patient becomes tachypneic or how the ventilator settings are changed. Increased volumetric CO2 production is the best index, if this is available (volumetric capnography integrates the amount of CO2 over time, to determine the total CO2 production by the patient).This may initially manifest as tachypnea with an elevated minute ventilation, which can obscure the increase in CO2 production. If the patient is able to trigger the ventilator, the patient may increase their respiratory rate in efforts to clear CO2.Increased end-tidal CO2 will occur if the minute ventilation is fixed (e.g., if the patient is deeply sedated).Increased metabolic rate usually manifests with an increased end-tidal CO2 and/or minute ventilation:.

Patients with central core myopathy are predisposed to develop malignant hyperthermia.

MH usually occurs intraoperatively or in the very early postoperative period (up to an hour after finishing anesthesia).

Malignant hyperthermia (MH) can be caused by any inhalational anesthetic, other than nitrous oxide.

Target co2 with tidal volume calculator