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patients are evaluated with well-described evidence-based screening tools," says Dr. Vitcov. "Patients who fall out are closely reviewed by an internal medicine physician and an anesthesiologist, and if they're inappropriate for surgery in an ASC, we redirect them to our affiliated hospital." It's a self-righting process, says Dr. Vitcov, because any of the cen- ter's 25 anesthesiologists call him out if they encounter a patient they're not comfortable sedating and ask why he approved them for surgery. "I must have a rationale and reasonable way to justify any patients who are approved to undergo surgery at the center," he says. Dr. Vitcov developed written evidence-based policies to help him make his case when surgeons ask why a patient can't undergo a proce- dure in the center. "I'll tell them what the literature says about post-op complication risks for similar patients," he says. "Clearly stated written guidelines show surgeons exactly why patients were or weren't approved for surgery." Dr. Vitcov sets con- servative screening thresholds and gradu- ally inches them up as positive outcomes build. For example, he originally set a BMI limit of 40 for the cen- ter, but saw that those 6 0 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 O N L I N E | S E P T E M B E R 2 0 1 5 O R E X C E L L E N C E AWA R D S O R E X C E L L E N C E AWA R D S *from the date of manufacture † or until solution is clear Important Safety Information The use of Revonto in the management of malignant hyperthermia crisis is not a substitute for previously known supportive measures. These measures must be individualized, but it will usually be necessary to discontinue the suspect triggering agents, attend to increased oxygen requirements, manage the metabolic acidosis, institute cooling when necessary, monitor urinary output, and monitor for electrolyte imbalance. Patients who receive i.v. dantrolene sodium preoperatively should have vital signs monitored. If patients judged malignant hype If patients judged malignant hyperthermia susceptible are administered dantrolene sodium preoperatively, anesthetic preparation must still follow a standard malignant hyperthermia susceptible regimen, including the avoidance of known triggering agents. Monitoring for early clinical and metabolic signs of malignant hyperthermia is indicated because attenuation of malignant hyperthermia, rather than prevention, is possible. Despite initial satisfacto Despite initial satisfactory response to i.v. dantrolene there have been reports of fatality, which involve patients who could not be weaned from dantrolene after initial treatment. The administration of i.v. dantrolene is associated with loss of grip strength and weakness in the legs, as well as drowsiness and dizziness. There have been reports of thrombophlebitis following administration of intravenous dantrolene. Tissue necrosis secondary to extravasation has been reported. Injection site reactions (pain, erythema, swelling), commonly due to extravasation, have been reported. Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with dantrolene sodium therap type may occur with dantrolene sodium therapy. To see the full prescribing information visit www.revonto.com. © 2015 US WorldMeds, LLC. Revonto is a registered trademark of US WorldMeds, LLC. 36 month shelf life* Ready to administer in 20 seconds † Visit www.revonto.com or call (877) 411-USWM (8796) to learn more about Revonto and to see the full Prescribing Information. REV-P74-0515 ® Are You Prepared for a CRISIS? 6ISIT US AT /28