M A R C H 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 6 9
MH crisis. What if it's the end of the day — just you, a nurse and
the secretary. The more people you educate, the safer you'll be.
• Don't dump expired dantrolene. Use it for your drills! You
paid for it, don't waste it. Tell your staff what it does and how it
feels to mix it up. In an MH crisis, if you're mixing up dantrolene
for the first time, you won't know what color it should be, when
it's completely reconstituted or how long it takes. You won't know
the amount of pressure it takes to draw up. Once you've done it,
an emergency won't be as stressful.
• Engage your surgeons. Sometimes reluctant participants in
MH drills, surgeons don't realize their vital role. They'll say they
don't have time. When the surgeon's sitting there, about to make a
phone call, I'll say, "Okay, Dr. Smith, what's your role in an MH
event? What are you supposed to do?"
• Assemble an online pre-op survey. Our patients complete a
standard online medical history, but we added questions. Ever
had a fever after anesthesia? A family member admitted to ICU or
overnight stay as a direct result of anesthesia? What about mus-
cular diseases, heat stroke, dark urine after physical activity (a
sign of rhabdomyolysis, which occurs during MH). If we get affir-
mative responses, a nurse calls the patient to get more details.
The anesthesiologist reads the responses, too, and might call the
patient if it's unclear what's going on.
• Prepare for transport. Know how you'll get the patient
packed for the hospital — Foley in place, lines in place, blood
drawn, intubated, additional airway equipment in case the patient
extubates, extra dantrolene (ambulances don't stock it).
• Stock charcoal vapor filters. These ensure your anesthesia
machines release an almost imperceptible amount of residual
