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Calculate your patient's LCRS Diagnostics Dantrolene Documents MH emergency trolley and ACFs
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Qs and As

What's the recommendation for machine preparation for the modern ADU machine's?
The newer anaesthetic machines are more complex and they have lots of small plastic parts in ther inner circuit. This functions as a huge reservoir for absorbed anaesthetic vapour and therefore needs more time to flush out. The old practice of 10 l/min oxygen flush for 10minutes are insufficient and dangerous. Check each machine's manufacture manual for specifics but most need a flush time of at least 40 minutes. 60 minutes @ 10l/min will ensure a vapour concentration of below 5ppm which is believe to be a threshold value.make sure flow rates are kept at 10l/min throughout the procedure to prevent the rebound phenomena.

What about an activated charcoal filter?
This can reduce the amount of vapour drastically and must be placed in both the inspiratory and expiratory limb of the breathing circuit.

Why refer a MHS patient?
Refer a patient and save a family! MH is not a disease of individuals but a disease that affects families. By diagnosing one patient, the lives of the whole family may be saved. The MHCSA analyze the family by means of a detailed genogram and identify the patients at risk as well as diagnose them. The MHCSA also equip the patient with information and a medic-alert to make them MH-wise. Lastly the MHCSA serves as a support group for terrified families with MH.

Why is a MH crash cart important?
With MH every second counts. Once an acute MH episode triggered, precise and immediate action is of the utmost importance to prevent a relentless irreversible cellular cascade of rhabdomyolysis and cell lysis. Because a fulminant MH crisis can kill a patient in minutes and because dantrolene does not mix and administer easily, a standardized and regularly checked MH crash cart must be available in every theatre complex.The content of such a crash cart can be obtained from the MHCSA. This is like a defibrillator, it is kept ready for use at all times, even though the need is rare.

How many ampules of dantrolene is enough?
The recommended minimum dantrolene stock for any theatre complex is 36 vials. This is the emergency dose for a 72kg adult. This is primarily a Health and Safety issue.

How do you mix dantrolene?
Reconstitution of 1 ampule of dantrium(20mg) is with 60ml of sterile water without a bacteriostatic agent.Dantrolene may be stored at room temperature but the water for diluting may not be stored in a refrigerator; it may be stored in a warming cabinet designed to maintain fluid temperatures between 35-40C.

May the myopathy patient get scoline and vapour?
Myopathies that is definitely associated with MH is King-Denborough syndrome, Central core disease and Multiminicore disease. All MH triggers should be vigorously avoided. Like Duchenne's and Becker dystrophies there are numerous myopathies that are not directly linked to causative MH mutations but that can clinically trigger an MH-like crisis. In these cases all vapour and scoline should NOT be used. Especially where the scoline can cause hyperkalaemic cardiac arrest. Where there is doubt rather give a trigger-free TIVA and for the babies remember ketamine which is a safe alternative.

What about scoline allergy?
Be cautious for the patient presenting with a scoline allergy. Differentiate between an anaphylactic reaction, scoline apnoea and a true MH reaction.