MCH Anaesthesia
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Emergency & Crisis Resources

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Anaphylaxis

  1. Remove trigger — stop infusion/transfusion
  2. CALL FOR HELP
  3. Position: supine + legs elevated
  4. Adrenaline IM (anterolateral thigh) — FIRST LINE 0.01 mg/kg IM = 0.01 mL/kg of 1:1000 Repeat every 5 min if inadequate response. Max 0.5 mg.
    Adrenaline IV — titrate to response
    DoseVolume (1:10,000)
    Moderate 1–2 mcg/kg 0.01–0.02 mL/kg
    Life-threatening 4–10 mcg/kg 0.04–0.1 mL/kg
    Infusion 0.05–0.5 mcg/kg/min
    → run at 1–10 mL/hr    		 0.15 mg/kg 0.15 mL/kg of 1:1,000
    → make up to 50 mL
  5. 100% O₂ high-flow
  6. IV / IO access
  7. If hypotension: 0.9% NaCl IV bolus 10–20 mL/kg
  8. If bronchospasm: Salbutamol 2.5 mg (<20 kg) / 5 mg (≥20 kg) nebulised
  9. Second line: Hydrocortisone 4 mg/kg IV
  10. Monitor minimum 4 hrs; 12 hrs if severe reaction

Malignant Hyperthermia

  1. CALL FOR HELP — declare MH emergency
  2. STOP all volatile agents and suxamethonium immediately. Remove/flush vaporiser.
  3. Hyperventilate 100% O₂ — 2–3× MV, fresh gas 15 L/min
  4. Switch to TIVA (propofol infusion)
  5. Dantrolene — CRITICAL (dissolve each 20 mg vial in 60 mL sterile water)
    Loading: 2.5 mg/kg IV rapid 20mg vials
    Repeat: 1 mg/kg IV q5 min 20mg vials until controlled
    Max total: 10 mg/kg 20mg vials
  6. Active cooling if temp >38.5°C: ice packs axilla/groin/neck; cold IV saline 10–15 mL/kg
  7. Treat hyperkalaemia:
    NaHCO₃ 1 mmol/kg IV Ca gluconate 10% 0.5 mL/kg IV
  8. Target urine output >1 mL/kg/hr — consider mannitol or frusemide
  9. Transfer to ICU — monitor ≥24 hrs
  10. Notify family and refer for MH susceptibility testing
  11. MH Resource Kit →

LAST — Local Anaesthetic Systemic Toxicity

  1. STOP injecting local anaesthetic immediately
  2. CALL FOR HELP — declare LAST emergency
  3. Airway: 100% O₂, consider early intubation
  4. Seizures: Midazolam IV (avoid large propofol doses — cardiovascular depression) 0.1–0.15 mg/kg IV
  5. Intralipid 20% — START EARLY
    Bolus: 1.5 mL/kg IV over 1 min
    Infusion: 15 mL/kg/hr
    If no response at 5 min: repeat bolus ×2, double infusion rate
    Max cumulative: 12 mL/kg
  6. Cardiac arrest: CPR — prolonged (up to 60+ min)
    Adrenaline small doses only: ≤1 mcg/kg IV
    AVOID: vasopressin, Ca²⁺ channel blockers, β-blockers, lignocaine
  7. Consider ECMO if refractory cardiovascular collapse
  8. Post-event: monitor ≥6 hrs; ≥12 hrs if cardiac event occurred

Emergency drugs & equipment

  • Drugs coming soon
  • Equipment coming soon