The influence of diluent warming on dantrolene sodium mixing time

Every second counts for anesthesia patients afflicted by the often deadly condition known as malignant hyperthermia (MH).

According to research published in the April AANA Journal of the American Association of Nurse Anesthetists, the intravenous administration of life-saving dantrolene sodium (DS) can occur significantly faster thanks to a new method of warming the diluent that is used to prepare the DS for use.

Malignant hyperthermia is a silent, inherited metabolic disorder of the muscle that is triggered by specific inhaled anesthetics or succinylcholine and can result in a severely high body temperature. Affected individuals usually appear normal and have no functional difficulties in everyday life. However, when these individuals receive anesthesia for surgery or some other procedure, this silent disorder can turn deadly. Treatment with DS, a muscle relaxant that restores a healthy level of calcium in the muscles and reduces high body temperature, prevents mortality when administered properly.

The study, titled "The Icarus Effect: The Influence of Diluent Warming on Dantrolene Sodium Mixing Time," set out to determine the possibility of a more expedient method of warming the diluent in order to mix it with DS, thus saving precious time between the onset of MH and the administration of DS. It was conducted by Kevin Baker, CRNA, MSNA, staff nurse anesthetist for West End Anesthesia Group at St. Mary's Hospital in Richmond, Va.; Donna Landriscina, CRNA, MSNA, assistant professor and assistant director of education in the Department of Nurse Anesthesia, Virginia Commonwealth University, and staff nurse anesthetist at Virginia Commonwealth University (VCU), Medical Center in Richmond, Va.; Heather Kartcher, RN, BSN, a second year graduate student in the Department of Nurse Anesthesia at VCU; and David Mirkes, RN, BSN, a second year graduate student in the Department of Nurse Anesthesia at VCU.

The researchers discovered that by warming the DS diluent (sterile water) to 41 degrees Celsius it safely lessoned the mixing time and resulted in faster treatment of patients suffering from MH. Thirty seconds or more could be shaved off the DS preparation process, which normally takes two minutes. To conduct the study, two standard fluid warmers were used that are typically found in hospital operating rooms around the country.

"Every second counts when treating a patient with malignant hyperthermia," said Donna Landriscina, CRNA, MSNA. "This research indicates that it is possible to administer DS faster, thereby increasing the patient's chances of a successful outcome."

The diagnosis of malignant hyperthermia in a patient requires swift action on the part of the anesthesia provider. The key to effectively controlling an MH crisis is the quick administration of DS. Since its introduction into clinical practice in 1979, DS continues to be the first-line of defense against reducing the MH mortality rate from nearly 80 percent in the 1970s to less than 10 percent today.

"For years, nurse anesthetists have been on the forefront of research that has greatly enhanced anesthesia safety," said Kevin Baker, CRNA, MSNA. "New discoveries of best practices such as this one will benefit patients for decades to come."