BNF for Children 2011-2012

648 15.1.8 Drugs for malignant hyperthermia BNFC 2011–201215 Anaesthesiamajor surgery; head injury (rapid reversal of benzodiazepinesedation may cause convulsions)Contra-indications life-threatening condition (e.g.raised intracranial pressure, status epilepticus) controlledby benzodiazepinesHepatic impairment carefully titrate dosePregnancy not known to be harmfulBreast-feeding avoid breast-feeding for 24 hoursSide-effects nausea and vomiting; less commonlypalpitation, anxiety, fear; also reported transienthypertension, tachycardia, flushing, agitation, convulsions(particularly in those with epilepsy), dizziness,sensory disturbance, chills, sweatingLicensed use not licensed for use in children under 1year; not licensed for use by intravenous infusion inchildren; not licensed for use in children in intensivecareIndication and doseReversal of sedative effects of benzodiazepines. By intravenous injection over 15 secondsNeonate 10 micrograms/kg, repeat at 1-minuteintervals if requiredChild 1 month–18 years 10 micrograms/kg(max. 200 micrograms), repeated at 1-minuteintervals if required; max. total dose of 50 micrograms/kg(1 mg) (2 mg in intensive care). By intravenous infusion, if drowsiness recursafter injectionNeonate 2–10 micrograms/kg/hour, adjustedaccording to responseChild 1 month–18 years 2–10 micrograms/kg/hour, adjusted according to response; max.400 micrograms/hourOverdosage with benzodiazipines see EmergencyTreatment of Poisoning p. 30Administration for continuous intravenous infusion,dilute with Glucose 5% or Sodium Chloride 0.9%Flumazenil (Non-proprietary) AInjection, flumazenil 100 micrograms/mL, net price5-mL amp = £14.49Anexate c (Roche) AInjection, flumazenil 100 micrograms/mL, net price5-mL amp = £13.66NALOXONE HYDROCHLORIDECautions cardiovascular disease or those receivingcardiotoxic drugs (serious adverse cardiovasculareffects reported); maternal physical dependence onopioids (may precipitate withdrawal in newborn); pain(see also under Titration of Dose, below); has shortduration of action (see notes above)Titration of dose In postoperative use, the dose should betitrated for each child in order to obtain sufficient respiratoryresponse; however, naloxone antagonises analgesiaPregnancy use only if potential benefit outweighs riskBreast-feeding not orally bioavailableSide-effects nausea, vomiting; hypotension, hypertension,ventricular tachycardia and fibrilation, cardiacarrest; hyperventilation, dyspnoea, pulmonaryoedema; headache, dizziness; less commonly diarrhoea,dry mouth, agitation, excitement, paraesthesia,tremor, sweating; very rarely seizures and erythemamultiformeIndication and doseReversal of respiratory and CNS depression inneonate following maternal opioid use duringlabour. By intramuscular injectionNeonate 200 micrograms (60 micrograms/kg) as asingle dose at birth. By intravenous or subcutaneous injectionNeonate 10 micrograms/kg, repeated every 2–3minutes if requiredReversal of postoperative respiratory depression. By intravenous injectionNeonate 1 microgram/kg, repeated every 2–3minutes if requiredChild 1 month–12 years 1 microgram/kg,repeated every 2–3 minutes if requiredChild 12–18 years 1.5–3 micrograms/kg; ifresponse inadequate, give subsequent doses of100 micrograms every 2 minutesOverdosage with opioids see Emergency Treatmentof Poisoning, p. 28PreparationSee Emergency Treatment of Poisoning, p. 2915.1.8 Drugs for malignanthyperthermiaImportantThe drugs in this section should be used by experiencedpersonnel only.Malignant hyperthermia is a rare but potentially lethalcomplication of anaesthesia. It is characterised by arapid rise in temperature, increased muscle rigidity,tachycardia, and acidosis. The most common triggersof malignant hyperthermia are the volatile anaesthetics.Suxamethonium has also been implicated, but malignanthyperthermia is more likely if it is given following avolatile anaesthetic. Volatile anaesthetics and suxamethoniumshould be avoided during anaesthesia inchildren at high risk of malignant hyperthermia.Dantrolene is used in the treatment of malignant hyperthermia.It acts on skeletal muscle cells by interferingwith calcium efflux, thereby stopping the contractileprocess.DANTROLENE SODIUMCautions avoid extravasation (risk of tissue necrosis);interactions: Appendix 1 (muscle relaxants)Pregnancy use only if potential benefit outweighs riskBreast-feeding present in milk—use only if potentialbenefit outweighs risk