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Chapter 17 Care of Intraoperative Patients

Terms in this set (115)

• Stop all inhalation anesthetic agents and succinylcholine.
• If an endotracheal tube (ET) is not already in place, intubate immediately.
• Ventilate the patient with 100% oxygen, using the highest possible flow rate.
• Administer dantrolene sodium (Dantrium) IV at a dose of 2 to 3 mg/kg.
• Administer 100% oxygen.
• If possible, terminate surgery. If termination is not possible, continue surgery using anesthetic agents that do not trigger malignant hyperthermia (MH).
• Assess arterial blood gases (ABGs) and serum chemistries for metabolic acidosis and hyperkalemia.
• If metabolic acidosis is evident by ABG analysis, administer sodium bicarbonate IV.
• If hyperkalemia is present, administer 10 units of regular insulin in 50 mL of 50% dextrose IV.
• Use active cooling techniques:•Administer iced saline (0.9% NaCl) IV at a rate of 15 mL/kg every 15 minutes as needed.
•Apply a cooling blanket over the torso.
•Pack bags of ice around the patient's axillae, groin, neck, and head.
•Lavage the stomach, bladder, rectum, and open body cavities with sterile iced normal saline.

• Insert a nasogastric tube and a rectal tube.
• Monitor core body temperature to assess effectiveness of interventions and to avoid hypothermia.
• Monitor cardiac rhythm by electrocardiography (ECG) to assess for dysrhythmias.
• Insert a Foley catheter to monitor urine output.
• Treat any dysrhythmias that do not resolve on correction of hyperthermia and hyperkalemia with antidysrhythmic agents other than calcium channel blockers.
• Administer IV fluids at a rate and volume sufficient to maintain urine output above 2 mL/kg/hr.
• Monitor urine for presence of blood or myoglobin.
• If urine output falls below 2 mL/kg/hr, consider using osmotic or loop diuretics, depending on the patient's cardiac and kidney status.
• Contact the Malignant Hyperthermia Association of the United States (MHAUS) hotline for more information regarding treatment: (800) 644-9737.
• Transfer the patient to the intensive care unit (ICU) when stable.
• Continue to monitor the patient's temperature, ECG, ABGs, electrolytes, creatine kinase, coagulation studies, and serum and urine myoglobin levels until they have remained normal for 24 hours.
• Instruct the patient and family about testing for MH risk.
• Refer the patient and family to the Malignant Hyperthermia Association of the United States at (800) 986-4287 or www.mhaus.org.
• Report the incident to the North American Malignant Hyperthermia Registry at the University of Pittsburgh: (412) 692-5464.