Outpatient Surgery Magazine

Manager's Guide to Surgery's Ambulatory Anesthesia - July 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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2 8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5 ing an MH episode. 6. We don't use volatile anesthetic gases. We got rid of our succinylcholine. We don't need to have dantro- lene on hand, right? Technically, this is true — but that doesn't make it smart. Accrediting agencies require facilities to stock the right amount of dantrolene if they have anesthetic gas or succinylcholine on the premises. Recently, centers that use only intra- venous anesthesia, like propofol, have gotten rid of their succinylcholine just to avoid the cost of dantrolene, which usually runs several thousand dollars every 2 years. This move can have deadly consequences. Succinylcholine, which produces immediate intense paralysis, is the most important medication in the anesthesi- ologist's drawer because it can treat life-threatening hypoxemia from airway obstruction before brain damage occurs. You are much more likely to need succinylcholine to save someone's life than dantrolene. Don't skimp — make sure you stock succinylcholine and dantrolene to keep your patients safe. OSM *from the date of manufacture † or until solution is clear Important Safety Information The use of Revonto in the management of malignant hyperthermia crisis is not a substitute for previously known supportive measures. These measures must be individualized, but it will usually be necessary to discontinue the suspect triggering agents, attend to increased oxygen requirements, manage the metabolic acidosis, institute cooling when necessary, monitor urinary output, and monitor for electrolyte imbalance. Patients who receive i.v. dantrolene sodium preoperatively should have vital signs monitored. If patients judged malignant hype If patients judged malignant hyperthermia susceptible are administered dantrolene sodium preoperatively, anesthetic preparation must still follow a standard malignant hyperthermia susceptible regimen, including the avoidance of known triggering agents. Monitoring for early clinical and metabolic signs of malignant hyperthermia is indicated because attenuation of malignant hyperthermia, rather than prevention, is possible. Despite initial satisfacto Despite initial satisfactory response to i.v. dantrolene there have been reports of fatality, which involve patients who could not be weaned from dantrolene after initial treatment. The administration of i.v. dantrolene is associated with loss of grip strength and weakness in the legs, as well as drowsiness and dizziness. There have been reports of thrombophlebitis following administration of intravenous dantrolene. Tissue necrosis secondary to extravasation has been reported. Injection site reactions (pain, erythema, swelling), commonly due to extravasation, have been reported. Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with dantrolene sodium therap type may occur with dantrolene sodium therapy. To see the full prescribing information visit www.revonto.com. © 2015 US WorldMeds, LLC. Revonto is a registered trademark of US WorldMeds, LLC. 36 month shelf life* Ready to administer in 20 seconds † Visit www.revonto.com or call (877) 411-USWM (8796) to learn more about Revonto and to see the full Prescribing Information. REV-P74-0515 ® Are You Prepared for a CRISIS? 6ISIT US AT /28 Dr. Litman (litmanr@email.chop.edu) is the medical director of the Malignant Hyperthermia Association of the United States' hot- line and a professor of anesthesiology and pedi- atrics at the Children's Hospital of Philadelphia. He's also the medical director of the Institute for Safe Medication Practices.

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