to stabilize the patient. A lot happened during that
time. To give you some perspective, here's a minute-
by-minute account of everything that occurred:
09:19 The anesthesia fellow noticed the first
signs of MH: sudden onset of "seizure-like"
tremors, tachycardia and rapid increase of
end-tidal carbon dioxide.
09:21 The anesthesiologist had a strong suspi-
cion of an MH crisis, and discontinued and scav-
enged sevoflurane. At that moment I received a
phone call from the OR coordinator.
09:23 I arrived in the operating room. The MH
cart was already in the room, the
anesthesia assistants had just
installed carbon filters in the
breathing circuit and dantrolene
vials were out of the box.
Although MH signs seemed to be
resolving, I confirmed that IV
dantrolene was still indicated and
recruited every available member
from the OR team (the surgeon
and his assistant, three OR nurs-
es, the anesthesia coordinator and
myself) for reconstituting the
dantrolene. We grabbed one vial
each for a total of seven vials (140
mg dantrolene) needed for the ini-
tial dose. The content from each
vial (20 mg per vial) was reconsti-
tuted with sterile water and
directly transferred into 60 mL
syringes that were used to admin-
ister dantrolene through the
patient's peripheral IV line — one
after the other.
09:28 We finished administer-
ing the last syringe of dantrolene.
The MH signs had resolved. The
decision was made to postpone
the procedure and transfer the
patient to the ICU.
If it happens to you
There are three things you and
your team should immediately do
if you suspect your patient is
experiencing MH:
• stop (and scavenge) the
triggering anesthetic agent,
• call for help, and
• administer dantrolene.
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