J U LY 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 3 1
needed to treat a stricken patient is roughly 2.2 to 2.5 mg/kilo. Ryanodex, the
newest preparation, comes in 250 mg vials and can be dissolved with 5 to 10 ml
of sterile water. Dantrium and Revonto come in 20 mg vials and require 60 ml of
sterile water for reconstitution. That's a time-consuming process that requires
quite a bit of manpower.
Fewer vials of Ryanodex are needed to deliver the initial dose, but the agent is
more expensive than the other options. Some facility leaders opt to stock the
less expensive Dantrium and Revonto to safeguard against a rare event, and
that's a rational argument, especially if your surgical team is big enough to
reconstitute the formulations quickly and efficiently. Smaller outpatient centers
with a limited amount of backup help might be better served with the more
expensive Ryanodex, which can be mixed with less effort and in less time.
Regardless of which dantrolene product you stock, make sure the supply is
current and there's enough to administer the stabilizing or typical maximum
dose: 36 vials of Dantrium or Revonto, or 3 vials of Ryanodex.
9. What else should I stock in my MH cart? Store sodium bicar-
bonate, dextrose, calcium chloride or calcium gluconate, regular insulin and
refrigerated cold saline solution for IV cooling. These drugs are used to treat the
deadly consequences of MH, including high potassium levels that can stop the
patient's heart. Also stock basic supplies such as syringes, IV catheters, nasogas-
tric tubes and Toomey irrigation syringes.
10. How common is MH? Not very. The incidence of anesthetic-related
episodes of MH is between 1 in 15,000 in children and 1 in 50,000 in adults,
according to MHAUS. They're rare events, to be sure, but can occur in
patients who are unaware of their susceptibility or who have been previously
anesthetized without incident.
OSM
Dr. Watson (cbwmdct@aol.com) is an anesthesiologist at
Bridgeport (Conn.) Hospital and a consultant for the
Malignant Hyperthermia Association of the United States.
