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S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2 0 1 4
with general questions or for guidance when
deciding whether to operate on a high-MH-risk
patient.
• Start treatment.
Discontinue the administration
of volatile anesthetic agents and succinylcholine,
change the anesthesia breathing circuit, hyperven-
tilate the patient with 100% O
2
, apply bags of ice
to initiate surface cooling and begin mixing and
administering the rescue agent dantrolene.
You must have 36 vials of IV dantrolene
2.5mg/kg on hand if you use triggering agents or
succinylcholine, enough to deliver the maximum 10mg/kg dose to a 70kg
patient. Reconstituting dantrolene vials with sterile preservative-free water is a
labor-intensive process that demands help from as many members of your clini-
cal staff as possible.
• Transfer for follow-up care.
The experts published in Anesthesia and
Analgesia say MH-stricken patients should be transferred to an acute care hos-
pital when, if possible, they're deemed stable: ETCO
2
is declining or normal,
heart rate is declining or stable with no signs of abnormal beats, the administra-
tion of dantrolene has begun, core body temperature is declining and general-
ized muscle rigidity, if present, is resolving.
"Appropriate arrangements must be in place to transfer patients to a medical
center that has an ICU," says Randall Klotz, CRNA, MEd, MSN, an anesthetist
who practices at Miami Valley Hospital and Far Hills Surgical Center in
Germantown, Ohio. "This would include a mobile intensive care unit transfer
team or, at a minimum, an ACLS-qualified transport team."
Too risky for ASCs?
Mortality associated with MH events is much higher in outpatient settings than
in acute care hospitals, according to Ms. Clifford. "The misconception is that
patients seeking surgery in outpatient settings are basically healthy, but MH can
P A T I E N T S A F E T Y
Pamela
Bevelhymer,
RN,
BSN
IN THE CARDS Make sure
everyone knows exactly what
to do when rehearsals turn real.
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