What is the role of the nurse in malignant hyperthermia? A critical guide

September 24, 2025 •

3 min read

Malignant Hyperthermia (MH) affects an estimated 1 in 10,000 to 50,000 people who receive general anesthesia, making preparedness crucial for all medical staff. A nurse's role in malignant hyperthermia is paramount, encompassing vigilance, rapid response, and critical life-saving interventions during this rare but severe hypermetabolic crisis.

Quick Summary

The nurse's critical role in malignant hyperthermia involves immediate recognition of early signs, mobilizing the emergency response team, administering the antidote dantrolene, implementing aggressive cooling measures, managing complications, and educating susceptible patients and their families.

Key Points

Preoperative Screening: Nurses play a crucial role in preventing malignant hyperthermia by screening patients for personal and family history of anesthesia-related issues and muscle disorders.
Rapid Recognition: Recognizing early signs, such as an unexplained increase in end-tidal CO2 and tachycardia, is critical for prompt initiation of the emergency protocol.
Team Coordination: The circulating nurse is responsible for calling the MH emergency and coordinating the team response, including securing the MH cart and additional help.
Dantrolene Administration: Nurses are responsible for preparing and administering dantrolene, the life-saving antidote, which requires swift action and careful reconstitution.
Aggressive Cooling: Implementing rapid and aggressive cooling measures, including ice packs and chilled IV fluids, is a primary nursing intervention to combat the dangerously high body temperature.
Post-Crisis Monitoring: Patients require at least 24-48 hours of intensive care monitoring for potential recurrence of MH signs and symptoms.
Patient and Family Education: Post-crisis, nurses educate patients on their MH susceptibility, the importance of carrying a medical alert ID, and the need for family members to be screened.

Understanding the Threat: What is Malignant Hyperthermia?

Malignant hyperthermia (MH) is a rare, inherited disorder that can cause a severe reaction to certain anesthetic gases and the muscle relaxant succinylcholine. This triggers a hypermetabolic state in skeletal muscles, leading to dangerous symptoms like high body temperature, muscle stiffness, and an unstable cardiovascular system. It requires immediate treatment to prevent serious complications or death.

The Nurse's Role in Preparation and Prevention

A key part of the nurse's role is preventing an MH crisis by identifying at-risk patients and ensuring preparedness. This includes:

Patient Screening: Gathering a detailed family and personal medical history during the preoperative assessment is crucial to identify any history of anesthesia reactions or muscle issues.
Risk Identification: Patients with certain muscle diseases or a history of unexplained muscle breakdown are at higher risk and should be flagged to the anesthesia team.
Emergency Preparedness: Ensuring the MH cart, containing all necessary supplies and protocols, is stocked and accessible in areas where triggering agents are used is a vital nursing responsibility.

Immediate Nursing Response During an MH Crisis

If MH is suspected, a rapid and coordinated nursing response is essential. Specific actions are critical for a swift resolution:

Critical Actions for the Circulating Nurse

Call for Help: Immediately alert the team by announcing an MH emergency and requesting the MH cart.
Cease Triggering Agents: Assist in stopping all volatile anesthetics and succinylcholine.
Prepare Medications: Prepare dantrolene sodium, the specific antidote, which requires reconstituting multiple vials quickly.
Initiate Cooling: Begin aggressive cooling with ice packs and chilled IV fluids.

Actions for the Medication and Monitoring Nurse

Medication Administration: Administer dantrolene and other ordered medications to manage complications like hyperkalemia.
Insert Lines: Insert a Foley catheter to monitor urine output and assess for kidney complications.
Monitor Vitals: Continuously monitor temperature, heart rate, rhythm, and end-tidal CO2 to evaluate treatment effectiveness.

Nursing Interventions for Managing Complications

Nurses are also vital in managing potential complications that can arise from an MH crisis, providing ongoing monitoring and supportive care for conditions like:

Hyperkalemia: Managing elevated potassium levels resulting from muscle breakdown.
Metabolic Acidosis: Assisting with treatments to correct the body's acid-base imbalance.
Rhabdomyolysis: Monitoring for and preventing kidney damage caused by muscle breakdown.
Disseminated Intravascular Coagulation (DIC): Watching for and assisting with treatment of this clotting disorder.

Comparison of Nursing Roles in an MH Crisis


Feature	Circulating Nurse	Medication Nurse	Cooling Nurse
Primary Role	Directing emergency response and resource mobilization	Preparing and administering medications	Implementing active cooling measures
Key Tasks	Call for help, secure MH cart, assist with dantrolene setup	Mix dantrolene, draw up ordered drugs (e.g., bicarb, glucose)	Apply ice packs, run chilled IV fluids, use cooling blankets
Focus	Initial crisis management and team coordination	Pharmacological treatment and complication management	Symptomatic relief and temperature control
Immediate Action	Overhead page, stop triggering agents, request staff	Confirm correct drug dosages and concentrations	Gather ice and cold solutions immediately

Post-Crisis Care and Patient Education

Following an MH crisis, patients need close observation in an ICU for 24-48 hours to watch for recurrence. The nurse's role includes:

Dantrolene Administration: Continuing maintenance doses of dantrolene as ordered.
Continuous Monitoring: Closely monitoring vital signs, lab results, and neurological status.
Patient Education: Educating the patient and family about MH susceptibility, the importance of informing healthcare providers, wearing a MedicAlert ID, and family screening.
Resource Referral: Connecting patients and families with resources like the Malignant Hyperthermia Association of the United States (MHAUS).

Conclusion: A High-Stakes Role

The nurse's role in malignant hyperthermia is comprehensive and critical, covering prevention, immediate emergency response, complication management, and post-crisis education. Their ability to quickly identify subtle signs and lead a rapid, effective team effort is paramount in saving lives during this rare but severe condition. Preparedness and training empower nursing teams to effectively manage this potentially life-threatening event.

Learn more about Malignant Hyperthermia from the Malignant Hyperthermia Association of the United States (MHAUS).

Frequently Asked Questions

The first action is to call for help and announce an MH emergency to alert the entire surgical and anesthesia team. A circulating nurse should immediately request the MH cart and solicit additional staff assistance, and the anesthesia provider should stop the triggering anesthetic agents.

Dantrolene is the only specific antidote for malignant hyperthermia. It works by stopping the excessive calcium release in muscle cells, which is the underlying cause of the hypermetabolic state. The faster it is administered, the lower the risk of severe complications and death.

Early signs can include an unexplained increase in end-tidal CO2 (the most sensitive early indicator), tachycardia, masseter muscle spasm (jaw stiffness), and mottled skin. Elevated body temperature, or hyperthermia, is a hallmark sign but is often a late symptom.

Nurses assist with cooling by applying ice packs to areas with major blood vessels (neck, axillae, groin), administering chilled intravenous (IV) fluids, and using cooling blankets. Cooling is stopped when the patient's temperature is below 38°C to prevent rebound hypothermia.

Due to muscle breakdown, hyperkalemia (high potassium) is a common complication. The nurse's role involves administering medications like insulin and glucose, as well as sodium bicarbonate, as ordered by the provider to help shift potassium back into the cells.

A Foley catheter is inserted to accurately monitor hourly urine output. Rhabdomyolysis during an MH crisis releases myoglobin into the bloodstream, which can cause kidney damage. Monitoring urine output helps assess kidney function and ensure adequate diuresis.

Post-crisis, a nurse educates the patient on the genetic nature of MH susceptibility, the need for all future healthcare providers to be aware of their condition, and the importance of wearing a medical alert ID. The nurse also encourages family screening due to the inherited risk.