Outpatient Surgery Magazine

No Guarantees - March 2017 - Subscribe to Outpatient Surgery Magazine

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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Page 72 of 138

M A R C H 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 7 3 drugs, equipment and supplies (osmag.net/ZawGX3). A lot goes into stocking an MH cart. The long list of drugs alone includes dantrolene, sterile water for injection USP, sodium bicarbonate, dextrose, calcium chloride, regular insulin, lidocaine and refrigerated cold saline solu- tion. We also assigned nurses and surgical techs to take an MH course and conducted an in-service to the entire perioperative staff. This included a PowerPoint presentation — "The ABCs of Managing MH," outlining each team member's role during an MH crisis, from pre-op to post-op, including the need to ask about any personal or family his- tory of MH during patients' pre-admission assessments — and a mock-drill DVD from MHAUS. Initially, we kept our MH cart in the core area, but the simulations taught us that location wasn't convenient for PACU, ICU or pre-op. We moved the cart out of the sterile area and into a neutral space in the hallway across from the front desk so it's more accessible to any- one in perioperative care. Our nursing staff had no experience reconstituting dantrolene sodi- um — the only medication known to reverse the effects of MH — before our yearly drills. Since 2015, they have been using expired vials of dantrolene to practice so they could feel confident handling the most vital aspect of MH response. As you can see in the table below, each of the 3 dantrolene formulations is unique. We've practiced using Revonto and Dantrium. You use 60 mL of sterile water to reconstitute a vial of either 20 mg formulation. You'll need to reconstitute 8 vials of each for an initial dose on a 140-pound patient. There's also Ryanodex, a newer MH drug that contains a much more concentrated dose of dantrolene. To reconstitute Ryanodex, which contains 250 mg of dantrolene per vial, you use 5 mL of sterile water in a single vial, which is all you need for an initial dose.

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