MHAUS Newsletter, April 2008
In this issue:

MHAUS Annual Report Available Online

Did you know that you can access the MHAUS Annual Report online?  You can download a PDF of the 2006 – 2007 annual report by visiting http://patients.mhaus.org/index.cfm/fuseaction/Content.Display/PagePK/AnnualReport2007.cfm

 

 

The annual report outlines MHAUS’ goals, ongoing services, and programs and initiatives.  The report also lists members of the Board of Directors, the Professional Advisory Council (PAC), the MHAUS administrative office, and the North American MH Registry (NAMHR).

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MHAUS Issues Consensus Statement Regarding Dantrolene Reconstitution with Warmed Diluent

MHAUS recommends using the manufacturer’s instructions regarding the reconstitution of dantrolene.  We recognize that dantrolene is a relatively insoluble drug in aqueous solution, even when it is packaged with both mannitol and base to enhance its solubility.  While there is no literature implicating the relative insolubility of dantrolene difficulty constituting a dantrolene solution as a cause for delayed treatment of an MH episode and poor outcome, timely dissolution does require extra personnel and the procedure can be stressful.

 

Recently, there have been a number of papers demonstrating that the use of warmed sterile water (~41°C) increases the dissolution of dantrolene significantly from 90-130 sec to 30-60 sec [1-3].  MHAUS acknowledges that warmed diluent (37-40°C) may expedite the reconstitution and delivery of dantrolene during an MH crisis, but we are unable to unequivocally recommend this practice as there is no evidence such practice would result in clinically significant outcome differences.  While there is no published evidence, there is the possibility that these temperatures induce drug breakdown, we consider this unlikely within the short time frame required for dissolution in sterile water at room temperature and injection.  If used, warmed diluent (sterile water for injection USP, without a bacteriostatic agent only) should be no more than 41°C, and it would be most economical to use vials or small bags of sterile water kept in standard temperature-controlled OR heaters. Great care must be taken when using warmed fluids for intravenous administration, as various warming methods may produce wide variation in temperatures, and a potential for vascular burns exists if too hot a solution is used. Moreover, warming methods that are rarely employed and, therefore, unfamiliar to the practitioner may increase dilution error or delay the most-important timely administration of intravenous dantrolene in MH crisis situations.

 

Reference List:

 

              [1]   Mitchell, L. W. and Leighton, B. L.: Warmed diluent speeds dantrolene reconstitution. Can.J.Anaesth. 2003; 50(2):127-130.

              [2]   Quraishi, S. A., Orkin, F. K., and Murray, W. B.: Dantrolene reconstitution: can warmed diluent make a difference? J.Clin.Anesth. 2006; 18(5):339-342.

              [3]   Baker, K. R., Landriscina, D., Kartchner, H., and Mirkes, D. M.: The Icarus effect: the influence of diluent warming on dantrolene sodium mixing time. AANA.J. 2007; 75(2):101-106.

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Get 50% Off In-Service Kit

Now you can get the updated MHAUS In-Service Kit at 50% Off (valued at $75.00) just by becoming a new or renewing MHAUS member.

This NEW In-Service Kit replaces the in-service videotape produced in 1994.  The 2006 updated version is a presentation on MH recognition and management, includes a mock MH drill, and instructions for mixing dantrolene, the MH antidote.  

The new presentation is in an entertaining format and includes recent updates to the educational material found in the previous in-service videotape.  It contains additional information relating to suggested dantrolene mixing, patient safety, risk management material, and a mock drill to reinforce the quick response time necessary in an MH event.

The In-Service Kit is for the OR team and contains the new 20-minute video in VHS and DVD format, plus a booklet of information and the test.  The kit offers one continuing educational credit for nurses and physicians.

To place your order, visit http://medical.mhaus.org/index.cfm/fuseaction/eShop.ItemGroupDetail/ItemGroupPK/E8971072-5487-4EC2-89DCEAF30A755C5E.cfm

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Speakers Bureau Promotes MH Awareness From Coast to Coast

The Speakers Bureau has given talks or has talks pending as far south as Florida as far west as California as far east as Long Island and many places in between.  Recent talks have taken place at Disc Surgical Center in Marina Del Ray, CA, by Dr. Jordan Miller, and Halofax Medical Center in Daytona Beach, FL, by Dr. Joe Tobin.

 

Further talks are scheduled for Carolina Center for Specialty Surgery in Charlotte, NC, on April 10 by Dr. Tobin, Providence Hospital in Mobile, AL, on April 14 by Dr. Mary Theroux, Texas A&M College of Medicine in Temple, TX, on June 5 by Dr. Gerald Gronert, and St. Mary’s Health Center in St. Louis, MO, on July 23 by Dr. Theroux.  Also, Dr. Charlie Watson is scheduled to speak at St. Vincent’s Medical Center in Bridgeport, CT, and Boulevard Surgical Center in Long Island, NY.  As well, there are pending talks in Michigan, California, Wisconsin, Colorado, New Jersey, and Kansas.

 

MHAUS offers, through our Speakers Bureau, information on MH crisis management, MH testing options, a mock drill of an MH episode, and question and answer sessions right at your facility.  MH experts can come to your facility or meeting and speak to your staff about malignant hyperthermia. MH experts are ready to offer insight and suggestions on the treatment regimen for MH should you find yourself facing a possible MH event.  MHAUS offers this service as an important tool to help you keep your patients safe and well.

 

To find out more information about this service, contact Diane at MHAUS either by phone, 607-674-7901 or by email at diane@mhaus.org.

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Look for MHAUS at These Upcoming Meetings

The MHAUS staff will be busy these next couple months as we spread the word about Malignant Hyperthermia (MH) and Neuroleptic Malignant Syndrome (NMS) awareness and preparedness at a number of professional meetings all the across the country.

 

MHAUS will attend the Association of periOperative Registered Nurses (AORN) meeting in Anaheim, California, from March 30-April 3; the American Psychiatric Association (APA) in Washington, DC, (NMS meeting) from May 3-8; the American Association of Critical Care Nurses (AACN-NTI) in Chicago, IL, from May 5-8; the American Society of PeriAnesthesia Nurses (ASPAN) in Grapevine, TX, from May 5-7; and the ASC Association in San Antonio, TX, from May 14-17.

 

Attendance at professional meetings such at these is vital to promoting MH awareness and preparedness, as well as a means to develop professional contacts and partnerships.  If you plan to attend any of these meetings, make sure you take the time to visit our informational booth.  We look forward to seeing you!

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Get Free Membership with Completed AMRA Form

In order to improve the completion rate of the Adverse Metabolic Reaction to Anesthesia (AMRA) forms, healthcare providers are now being offered a complimentary MHAUS membership for one year when they send in the completed AMRA form.

 

This membership includes specific benefits:

1.)    a 10% discount on materials ordered from MHAUS

2.)    the MHAUS quarterly newsletter, The Communicator

3.)    a member card

4.)    a New-member kit

 

Data from the AMRA forms are entered into the North American MH Registry.  The Registry helps MH experts learn how MH presents itself clinically by compiling a database of MH cases.  The Registry relies on anesthesia care providers filling out and sending in a thorough report of MH incidents or suspected cases.

 

AMRAs are available from the MH Registry www.mhreg.org, or calling the Registry at (888) 274-7899 or from the MHAUS office at (607) 674-7901

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