Malignant Hyperthermia - Dantrolene

Anaesthetists should be aware that between 1987-1999 there were only 5 cases of Malignant Hyperthermia (MH) reported to the Council, all successfully managed. However, there have been several recent reports of suspected MH, including one confirmed fatal case, and a re-evaluation of the provisions for management of this emergency is timely.

It is not the role of this Council to provide management protocols but it should be noted that there is a time critical period for administration of the initial dose of dantrolene of 2.5 mg/kg with subsequent doses up to 10 mg/kg, which also may be time critical, and concomitant cooling is also essential.

It is known that many hospitals maintain a supply of 18 vials of dantrolene and in city areas further supplies should be able to be rapidly obtained. However, in view of the recommendations of the Malignant Hyperthermia Association of the USA (external link) that 36 vials should be available in all surgical areas where general anaesthesia is performed, it is suggested that all hospitals, and in particular rural hospitals, should review the ready availability of the drug.

Also, recommended contents of the special MH trolley are:

Equipment

• treatment protocol
• temperature probes
• invasive monitoring catheters
• blood collection tubes for blood gases, electrolytes, platelets and coagulation studies

Other essential drugs

• 50% dextrose
• antiarrhythmics
• mannitol
• sodium bicarbonate
• frusemide

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