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MH & Dantrolene: Treatment & Prevention
- 1. Malignant Hyperthermia & Dantrolene Wilson, Kelly – Quiz 8
- 2. What is Malignant Hyperthermia? Malignant hyperthermia is a rare but deadly hypermetabolic event triggered by commonly used anesthetics and the paralyzing agent succinylcholine. Complications include cardiac arrest, brain damage, internal bleeding, organ system failure and death, due to cardiovascular collapse.
- 3. Dantrolene Dantrolene is THE drug for treatment of MH. It acts as a skeletal muscle relaxant by acting on calcium channels. Dantrium and Revonto are name brands o the generic dantrolene. 36 vials should be on hand when any trigger agents are used.
- 4. The Role of the Dantrolene Nurse Obtain MH cart. Start reconstituting Dantrolene by mixing each vial with 60ml preservative-free sterile water. Create a fluid path with short IV tubing and stopcock for rapid mixing. Use spikes for rapid injection into vial. Deliver via rapid IV push.
- 5. Principles of a Good PowerPoint Presentation For good visibility, the font should be simple and at least 28-30 point type. Follow the 7x7 or 8x8 rule; no more than 7-8 words per line and no more than 7-8 lines per slide. Avoid long paragraphs and text blocks. Each slide should address a single idea. The viewer/reader should be able to take in the entire slide in 10-20 seconds. More simples slides is better than fewer complicated slides. Do not read the slide to the viewers. Instead, expand on the ideas of the slides. KISS = Keep It Simple & Sequential; Make the slides easy to understand quickly and flow easily slide to slide. A maximum of 1-2 minutes of narration per slide
Editor's Notes
- Malignant Hyperthermia is a life threatening event triggered by specific anesthesia medications. It is an inherited disorder in which the rate of occurrence is debated, being as frequent as 1 in 5,000 or as rare as 1 in 65,000. Patients susceptible to MH have a defective calcium channel on the sarcoplasmic reticulum of their skeletal muscles. Symptoms arise from hypermetabolism of skeletal muscles as a result of uncontrolled release of calcium. Muscles contract, increasing metabolism, accompanied by massive oxygen consumption, production of carbon dioxide and excessive heat and ultimately resulting in cell membrane breakdown. The cascade event can happen quickly but is 100% reversible with rapid identification and treatment. Perioperative medical staff must be prepared for such a crisis with prevention as well as practice of treatment protocol.
- Dantrolene is the drug used for treating malignant hyperthermia. While there are other medications required during MH treatment, dantrolene is the key to reversing the cascade of events. Dantrolene suppresses the rise of calcium in muscles cells that trigger the MH response. Dantrolene must be given quickly and will continue to be given for up to 36 hours in the ICU if the patient survives the initial event.
- There are several key staff roles in the treatment of MH. One is that of the “dantorlene nurse”, which we will take a look at first. The dantrolene nurse is responsible for obtaining, mixing and the rapid push of the dantrolene. Dantrolene requires reconstitution with 60ml’s of sterile water and as many as 12 vials are needed for the initial treatment of a 200lb patient. Rapid treatment will continue until symptoms begin to subside. For quick organized delivery of the life saving medication, creation of a fluid path with a short IV tubing and stopcock along with large bore spikes to add the sterile water to the vials all help increase the rate of delivery. These supplies should part of the MH emergency supplies. Staff should practice creating the fluid path and reconstituting of the vials with expired supply of dantrolene as part of MH training.