In this episode, I’ll discuss the pharmacist’s role if malignant hyperthermia is suspected outside of the operating room.
Malignant hyperthermia is a rare event, occurring in about 1 out of 100,000 administrations of anesthesia. While MH is usually thought of as occurring in the operating room, it can occur an hour after anesthesia or anywhere succinylcholine has been administered, making its occurrence outside of the OR a real possibility.
The treatment for MH is prompt administration of dantrolene. Dantrolene is a skeletal muscle relaxant that interferes with the release of calcium ions from the sarcoplasmic reticulum. By lowering the myoplasmic calcium ion concentration, the sustained muscular contraction present in MH is ended along with the acute catabolic process.
Because the risk of mortality and morbidity increases for every 10-minute delay in giving dantrolene, I believe the main focus of the pharmacist should be obtaining and preparing the first dose of dantrolene. A secondary focus can be to get the expertise of an anesthesiologist to the bedside because it is likely that the pharmacist has the knowledge of how best to rapidly contact local anesthesiologists or the national MH hotline.
To that end, when MH is suspected outside of the OR, the pharmacist can facilitate the care of the patient by taking the following steps:
1. Obtain the MH cart from the OR or PACU and bring it to the patient’s bedside.
2. If not already done by another clinician, use your phone to notify the anesthesia department and call them to the bedside while you are in the process of obtaining the cart.
3. When the cart is at the patient’s bedside, immediately prepare an initial dose of 2.5 mg/kg dantrolene.
4. If your anesthesia provider has not arrived, contact the MHAUS hotline, the number for which can be found at mhaus.org.
After the first dose of dantrolene is administered, supportive care will likely be directed by the anesthesiologist at the bedside or on the MH hotline.
Although this information might come up once or not even at all in a pharmacist’s career, having the knowledge of the location of your MH cart and anesthesia contact information has the potential to decrease the delay to dantrolene administration and provide the best chance for a positive patient outcome should MH occur outside of the OR.
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