Outpatient Surgery Magazine

Special Outpatient Surgery Edition - Anesthesia - July 2019

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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3 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9 patients are stabilized and transferred to the ICU, they administer one of the other formulations as maintenance doses while patients are observed for recurrence. There are other medications you should have available in MH carts, including: • sodium bicarbonate 8.4% to correct acid-base disturbances; • insulin to treat high potassium levels; • dextrose 50% to co-administer with insulin to maintain normal blood sugar levels; • calcium chloride 10% to protect the heart from severe hyper- kalemia; and • lidocaine and amiodarone to treat cardiac arrhythmia. Also fill the MH cart with the sterile water needed to reconstitute dantrolene — MHAUS suggests storing the water in 100 vials instead of bags to prevent accidental IV administration — and supplies for administering the emergency response drugs, including needles, syringes and IV catheters. You can store other supplies you'll need during an MH crisis in the cart's lower drawers, says Dr. Hamlin. Among the items you'll want to include: temperature monitoring equipment, transducers for pressure monitoring of arterial or central venous lines, a urodynamic meter, Foley catheters, plastic bags to collect ice and single-use ice packs to help cool the patient. Some carts have an integrated refrigerator for storing insulin and cool saline solution (at least 3,000 ml is needed for IV administration, according to MHAUS) to help lower the patient's body temperature during an acute MH crisis. Also keep in mind that anesthesia providers must hyperventilate patients with 100% oxygen at the first sign of MH onset. You can insert charcoal filters into the anesthesia machine's breathing circuit to absorb the volatile anesthetics that trig-

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