Management of Elevated EtCO2

Immediate Assessment and Differential Diagnosis

An unexplained increase in carbon dioxide production with EtCO2 values of 80-86 mmHg strongly suggests malignant hyperthermia, especially if the patient has recently been exposed to triggering agents, according to the Anaesthesia society 1, 2
This extreme elevation in EtCO2 indicates severe hypoventilation that cannot be easily controlled by increasing minute ventilation, as stated by the Anaesthesia society 1
Monitor for increasing heart rate, an upward trend in heart rate accompanying increased carbon dioxide production is highly suggestive of MH, as per the Anaesthesia society 1
Check for temperature elevation, although it may still be within normal range early in an MH reaction, as noted by the Anaesthesia society 2
Look for muscle rigidity, which may occur during an MH reaction even in the presence of non-depolarizing neuromuscular blockade, according to the Anaesthesia society 2
Assess for signs of hemodynamic instability which may accompany severe hypercapnia, as stated by the Circulation society 5

Immediately discontinue all triggering agents and deliver 100% oxygen at maximum flow and increase the patient's minute ventilation to 2-3 times normal for suspected malignant hyperthermia, as recommended by the Anaesthesia society 2
Administer intravenous dantrolene immediately and initiate active body cooling for suspected malignant hyperthermia, according to the Anaesthesia society 2
Delay in commencing treatment of MH is associated with increased mortality and complications, as stated by the Anaesthesia society 1

Continuously monitor EtCO2, heart rate, blood pressure, and oxygen saturation, as recommended by the Circulation society 5
Document trends in EtCO2 values rather than isolated readings, as suggested by the Praxis Medical Insights society, however, a more suitable reference is not available for this specific fact, thus it is 4