through an IV based on the patient's total body
weight, with as much as 10 mg/kg needed for
treatment of heavier patients weighing approxi-
mately 100 kg to 150 kg. Repeat until the patient
responds with a decrease in ETCO
2
, decreased
muscle rigidity and/or lowered heart rate. Large
doses (>10 mg/kg) may be required for patients
with persistent contractures or rigidity.
4. How much sterile water is needed to recon-
stitute each available version of dantrolene:
Revonto from US World Meds, Dantrium from
Par Pharmaceuticals and Ryanodex from
Eagle Pharmaceuticals?
a. 50 ml, 10 ml and 50 ml
b. 60 ml, 60 ml and 5 ml
c. 60 ml of sterile water for all three
Answer: b
Revonto and Dantrium are packaged in 20 mg
vials, which are reconstituted for injection by
adding 60 ml of sterile water and shaking until
the solutions are clear. Ryanodex comes in 250-
mg vials, which are reconstituted with 5 ml of
sterile water and shaken to ensure the solution
is an orange-colored, opaque suspension.
Thirty-six vials of Revonto and Dantrium and
three vials of Ryanodex should be stocked to
administer the initial dose.
5. How quickly should dantrolene be administered?
a. within 15 minutes
b. within 10 minutes
c. within 4 minutes
Answer: b
Dantrolene should be available for administra-
tion within 10 minutes of the decision to treat
for MH, and be available
for all anesthetizing loca-
tions where MH trigger
agents are used. This is a
slight modification of the
recommendation that the
drug must be administered
within five minutes, which
was not made based on
consensus discussion.
Having staff use vials of
expired dantrolene to prac-
tice reconstituting the drug
is an effective way to
ensure they're ready to
respond as quickly as pos-
sible during a real-life
event. Additionally, task
cards are a simple and
effective way to delegate
responsibilities during an
emergency response and
ensure responding staff
members know who's
assigned to begin reconsti-
tuting the dantrolene.
3 4 • 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 A N U A R Y 2 0 2 1
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