LAUSR

Malignant hyperthermia (MH) is an inherited disorder of the ryanodine receptors in skeletal muscle, triggered by inhalational anaesthetic agents and depolarising muscle relaxants. It is a rare and potentially fatal condition, which can bedifficult to diagnose and complex tomanage. The Association of Anaesthetists’ Guideline on MH management outlines key details in the recognition, treatment and monitoring [1], a key part of which is the preparation and administration of dantrolene. Dantrolene is prepared as a powder in vials containing 20 mg: each vial is mixed individually with 60 ml sterile water. Thus, in order to prepare the initial bolus of 2.5 mg.kg 1 for a 70 kg adult with MH, nine vials are required to be mixed as quickly as possible. Subsequent boluses may require a further 28 vials. Despite very few anaesthetists having experienced a case of MH during their career, it is well known that dantrolene can be time consuming to prepare, with the guidelines rightly recommending that one member of staff is designated purely to prepare dantrolene in an MH emergency. We noticed that our dantrolene supply in theatres was about to expire, and therefore designed and delivered a multidisciplinary ‘Bath Tea Trolley’ teaching session, run once the dantrolene had expired and using an education method previously described [2], to refresh knowledge of the Association of Anaesthetists’ MH guidance, to recap locating and calculating the correct loading dose of dantrolene and to practise actually making up the expired dantrolene. One key learning point from this training programme was that a Braun Mini-Spike (B.Braun Medical Ltd., Sheffield. UK), or similar, designed for drawing up 50 ml or 100 ml vials of propofol, was a much quicker and easier alternative for preparing vials of dantrolene, rather than using a standard drawing up needle. Given the time-critical and multifaceted approach to managing these patients, this simple improvement to one of the most important elements of the treatment algorithm seemsworthy of highlighting to the anaesthesia community.