mends for inclusion on an MH cart at be-prepared/what-should-be-on-an-mh- cart/). Effective preparation requires ASCs to keep these items stocked and ensure that any that expire are replaced immediately, Tobin says. While the list of items is fairly straightforward, surgery centers have decisions to make. One concern is choosing the formulation of dantrolene, the muscle relaxant that treats an MH episode. Tobin notes that there are now two options available. The older for- mulations are available under the brand names Dantrium and Revonto. “These come as 20 mgs per vial to

be mixed in 60 mls of sterile water,” Tobin says. “To deliver the recom- mended dose of 250 mgs of dan- trolene to a patient experiencing MH, that would require 13 vials be diluted and then drawn up into a large volume before it could be administered.” As of 2014, ASCs have another option: Ryanodex. It comes in a vial con- taining 250 mgs of dantrolene sodium to be diluted in 5 mls of sterile water, goes into solution instantaneously and can be administered as an intravenous bolus medication in just seconds. “While it tends to be more expensive than the older formulations, the ability to draw up and deliver the dose of Ryanodex is much more expeditious than giving a similar dose of dantrolene in the other formulations,” Tobin says. All facilities, including ASCs and

physician offices, where MH trigger- ing anesthetics and depolarizing mus- cle relaxants are administered, should stock dantrolene, along with the other drugs and devices necessary to treat an MH reaction, according to the MHAUS website. If none of these agents are ever in use in the facility, then dan- trolene need not be kept on hand. ASCs also should be aware of a

newer recommended addition to the MH cart, Tobin says: charcoal filters. “With the recent Food & Drug Admin- istration approval of activated charcoal filters that are attached to an anesthe- sia machine, a patient can be prevented from experiencing an accidental expo-

We ensure that everyone on our team understands their role by holding mock MH drills twice a year— one with our anesthesia providers, the other with our pharmacy consultant.”

—Fiona Stephan, RN, Vanguard Surgical Center

sure to an inhalation agent.” These fil- ters also can be applied immediately to the anesthesia circuit when an MH cri- sis begins to prevent further absorption of the volatile anesthetic and hasten the expiration of volatile anesthetic from the patient’s lungs. “Using charcoal fil- ters is a preventative measure and now part of the treatment paradigm,” he says.

Importance of Drills and Training Considering the unpredictable and fast- acting nature of MH, there is little room for error in a response effort, Stephan cautions. “We ensure that everyone on our team understands their role by hold- ing mock MH drills twice a year—one with our anesthesia providers, the other with our pharmacy consultant. Anesthe- siologists cover what they need to do and what we need to do to assist them. They also cover the possible metabolic issues a patient will manifest and how these will be handled.” The consulta- tive pharmacist covers the medications required for treatment, how to reconsti- tute them and how to calculate dose per body weight. “We take these drills seri- ously and treat them as if we were expe- riencing a real MH crisis.” Tobin recommends conducting drills inside and outside the operating room

(OR). “While MH typically presents in the OR, it can present in the PACU. Make sure staff understand how to respond in either area.” Treat every drill as a learning opportunity, Stephan says.


each drill, we, as a team, critique the experience and assess how cer- tain tasks might work better. We use a multidisciplinary approach where every voice is heard and everyone can contribute. We also learn from employees who have worked at other institutions and bring their ideas to the table. We review our protocols and change any that are needed to improve our performance.” ASCs seeking resources to improve preparation should explore the MHAUS website at, Tobin says. “There is a wealth of information on there and you do not need to be a mem- ber to access resources.” If you have any emergency ques- tions concerning MH, Tobin recom- mends calling the MHAUS hotline at 800.644.9737. The hotline is staffed 24 hours a day, seven days a week by MH experts, including Tobin. “An MH event can be overwhelming. We are here to provide any assistance we can to help you keep patients safe.”


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38