Anaes Cases · Malignant hyperthermia
The malignant hyperthermia crisis — rising ETCO2 in theatre
The live MH crisis — the sentinel unexplained ETCO2 rise, the declaration of MH, the full crisis bundle executed under time pressure (stop triggers, hyperventilate, dantrolene early, cool, treat hyperkalaemia, monitor, ICU), and the human-factors conduct of the team.
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Prompt
Thirty minutes into a sevoflurane anaesthetic in a young adult, the end-tidal carbon dioxide has climbed from 4.5 to 8.5 kPa despite increasing the minute volume, the heart rate is 120, and the patient's temperature has risen a degree. The circuit is intact. Manage this emergency.
Presentation
Thirty minutes into a sevoflurane anaesthetic, the end-tidal carbon dioxide climbs steeply to 8.5 kPa. The anaesthetist has already increased the minute volume, but the ETCO2 continues to rise. The heart rate is 120 and climbing, the patient is sweating, and the core temperature has risen a degree in ten minutes. The circuit is intact and there is no apparatus fault.[9]
References3ShowHide
- [8]Glahn KPE, Girard T, Hellblom A, et al. Recognition and management of a malignant hyperthermia crisis: updated 2024 guideline from the European Malignant Hyperthermia Group. British Journal of Anaesthesia, 2025.PMID 39482150
- [2]Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesthesia & Analgesia, 2010.PMID 20081135
- [9]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.