The only requirement the Malignant Hyperthermia Association of the United States (MHAUS) will not waiver on is this: Any facility using a trigger for malignant hyperthermia (potent volatile anesthetics and/or succinylcholine) must assure there is a sufficient supply of dantrolene sodium for injection available within 10 minutes, in whatever form the facility chooses to use.
Our customers tell us of their experiences with dantrolene and sometimes ask us which version MHAUS recommends – is one better than another? We leave that decision up to the facility’s management and those in charge of MH preparedness training. There are often mitigating factors that will affect the final determination of which version to use and we are not in a position to make that choice. From personal experience and feedback from our customers, we are confident all forms of dantrolene work as they must in order to stop an MH event from evolving into a life-threatening crisis.
Toward that end, we recently received feedback from a variety of facilities across the country (at least 15 states were represented in the feedback) to determine their personal stocking process. The data in general was interesting; 100% did indeed stock dantrolene – kudos to those in charge for being prepared for MH! Further breakout of this statistic revealed 32% were hospitals, 42% were ambulatory surgery centers and 26% were free standing office-based surgicenters.
Most of the responders to this particular question did not report which version of the dantrolene formulations they used, but a few (21%) specifically reported stocking the Ryanodex® version; therefore, it is assumed 79% of these specific respondents stocked either Dantrium® or Revonto®. Customers will share their thoughts from time to time as to why they or their facility stocks the version of dantrolene they presently use. Reasons vary as widely as the multiple types of facilities.
Points that caught my attention were 16% noted they assured their MH Cart was available within 10 minutes or in close proximity to any location that might need to quickly access the dantrolene.
Rather than throwing away the expired dantrolene, it could be used in MH mock drills to give staff the “real time” experience of quickly mixing and administering the antidote. “Hands on” training remains a strong and impactful educational experience for all involved.
As Bridion® (sugammadex) Injection for the reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults undergoing surgery was approved by the FDA, we have heard from some customers that they are replacing succinylcholine with rocuronium or vecuronium and stocking Bridion® (sugammadex) as well. This came out in the feedback.
One responder also shared that CMS’ (Centers for Medicare & Medicaid Services) language stipulated that any location using triggering agents need to be prepared to treat MH. This spurred the emergency room personnel to request that they also stock a sufficient supply of dantrolene. From my personal perspective, I am encouraged by the responsiveness of the ER staff to be prepared for MH and congratulate their concern for their patient’s safety. MHAUS needs to focus on MH education designed for this type of healthcare provider as they may also be involved in an MH scenario.
From the feedback in this particular exercise, the need for review of the facility’s readiness to treat an unforeseen MH event, including the appropriate stocking of dantrolene in whatever form is best for that particular facility, is an important consideration to review at least once each year. An MH mock drill is highly recommended to verify all staff are cognizant of the need to take immediate action, and often, everyone could become rapidly involved in lifesaving efforts. The answers provided positive reinforcement that the messages and recommendations we share from our MH experts are being heard and used – we appreciate the recognition from the facilities and the regulatory surveyors.
We are there for all who want answers or assistance and will always listen to your concerns/questions.