Malignant Hyperthermia: Intel for the OR

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The Fight Against Malignant Hyperthermia With Revonto® - Sponsored Content

Thinking of Buying Orthopedic Devices

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The Fight Against Malignant Hyperthermia With Revonto®
Sponsored Content

USWM

The early recognition and prompt treatment of a malignant hyperthermia (MH) crisis is essential for a patient’s survival. Healthcare professionals everywhere are on a mission to be prepared. USWM, LLC (US WorldMeds) offers a product – Revonto® (dantrolene) – that aids in the fight against MH in the patient’s surgical journey.

Revonto is indicated, along with appropriate supportive measures, for the management of fulminant hypermetabolism of skeletal muscle characteristic of malignant hyperthermia crises in patients of all ages.

Revonto should be administered by continuous rapid intravenous push as soon as the MH reaction is recognized – including tachycardia, tachypnea, central venous desaturation, hypercarbia, metabolic acidosis, skeletal muscle rigidity, increased utilization of anesthesia circuit carbon dioxide absorber, cyanosis and mottling of the skin, and, in many cases, fever. It is also indicated preoperatively, and sometimes postoperatively, to prevent or attenuate the development of clinical and laboratory signs of malignant hyperthermia in individuals judged to be malignant hyperthermia susceptible.

Revonto is a sterile, non-pyrogenic, lyophilized formulation of dantrolene sodium for injection. Revonto is supplied in 65 mL vials containing 20 mg dantrolene sodium, 3000 mg mannitol, and sufficient sodium hydroxide to yield a pH of approximately 9.5 when reconstituted with 60 ml sterile water for injection USP (without a bacteriostatic agent). Dantrolene sodium is classified as a direct-acting skeletal muscle relaxant. Chemically, dantrolene sodium is hydrated 1-[[[5-(4-nitrophenyl)-2-furanyl] methylene] amino]-2,4- imidazolidinedione sodium salt. The hydrated salt contains approximately 15% water (3.5 moles) and has a molecular weight of 399. The anhydrous salt (dantrolene) has a molecular weight of 336.

In isolated nerve-muscle preparation, dantrolene sodium has been shown to produce relaxation by affecting the contractile response of the muscle at a site beyond the myoneural junction. In skeletal muscle, dantrolene sodium dissociates the excitation-contraction coupling, probably by interfering with the release of Ca++ from the sarcoplasmic reticulum. The administration of intravenous dantrolene sodium to human volunteers is associated with loss of grip strength and weakness in the legs, as well as subjective CNS complaints.

Information concerning the passage of dantrolene sodium across the blood-brain barrier is not available. In the anesthetic-induced malignant hyperthermia syndrome, evidence points to an intrinsic abnormality of skeletal muscle tissue. In affected humans, it has been postulated that “triggering agents” (e.g., general anesthetics and depolarizing neuromuscular blocking agents) produce a change within the cell which results in an elevated myoplasmic calcium. This elevated myoplasmic calcium activates acute cellular catabolic processes that cascade to the malignant hyperthermia crisis.

Important Safety Information

The use of Revonto in the management of MH crisis is not a substitute for previously known supportive measures. These measures must be individualized, but it will usually be necessary to discontinue the suspect triggering agents, attend to increased oxygen requirements, manage the metabolic acidosis, institute cooling when necessary, monitor urinary output, and monitor for electrolyte imbalance. Patients who receive i.v. dantrolene sodium preoperatively should have vital signs monitored.

If patients judged MH susceptible are administered dantrolene sodium preoperatively, anesthetic preparation must still follow a standard malignant hyperthermia susceptible regimen, including the avoidance of known triggering agents. Monitoring for early clinical and metabolic signs of MH is indicated because attenuation of malignant hyperthermia, rather than prevention, is possible.

Despite the initial satisfactory response to i.v. dantrolene there have been reports of fatality, which involve patients who could not be weaned from dantrolene after initial treatment. The administration of i.v. dantrolene is associated with loss of grip strength and weakness in the legs, as well as drowsiness and dizziness. There have been reports of thrombophlebitis following administration of intravenous dantrolene. Tissue necrosis secondary to extravasation has been reported. Injection site reactions (pain, erythema, swelling), commonly due to extravasation, have been reported. Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with dantrolene sodium therapy.

To report suspected adverse reactions, contact US WorldMeds at 1-888-900-8796 or MEDWATCH at 1-800-FDA-1088 (1-800-332-1088) or https://www.FDA.gov/medwatch.

To see the full Prescribing Information, please visit www.revonto.com.

Thinking of Buying Orthopedic Devices

Orthopedics has a reputation for being one of the most innovative, cutting-edge service lines in outpatient surgery, and for good reason. Surgeons are obsessive about providing superior outcomes in the most efficient ways. They rely on the latest technology and equipment for successful outcomes.

With the orthopedic device market expected to reach $16.6 billion in 2025 in the United States — the country that represents the largest segment of the orthopedic device market globally — the choices available to decision-makers at ASCs and HOPDs are seemingly endless.

Whether you are in need of infection-prevention-bolstering bone cement or an all-encompassing platform for your total, partial and revision knee cases and total hip arthroplasties, there are plenty of options. Here is a sampling of orthopedic solutions that caught the attention of the Outpatient Surgery Magazine’s editors.

Autograft Tissue in a Few Simple Steps

Access healthy autograft tissue with ease when you use the GraftNet autologous tissue collector from Arthrex. All it takes is a few simple steps, according to the company. Attach GraftNet to suction, then attach this apparatus to either a shaver handpiece or suction wand. Insert the handpiece or wand where you want to collect tissue. Following collection, disassemble the apparatus. Withdraw a plunger from GraftNet to access the recovered tissue stored in a sterile-filtered chamber. GraftNet can be used for a variety of applications, including bone and cartilage grafting.

For more information, visit ad.arthrex.com/graftnet

Affordable Instruments You Can Trust!

Brasseler USA Surgical Instrumentation manufactures a comprehensive line of high-quality orthopedic cutting accessories made in the United States to rigid specifications, using high-quality surgical-grade materials. The company says facilities can save up to 60% when purchasing precision surgical instruments with no sacrifice in quality and no supply chain delays.

For more information, call (800) 535-6638 or visit BrasselerUSAmedical.com

Bone Cement with Added Infection Prevention

COPAL G+V (gentamicin and vancomycin), a high-viscosity bone cement providing high concentrations of gentamicin and vancomycin, is now available from Heraeus Medical. Effective against most PJI-related pathogens and MRSA/MRSE, this PMMA bone cement is intended for fixation of COPAL exchange G hip spacer to the host bone. Heraeus says COPAL G+V offers high local antibiotic elution with a low systemic load.

For more information, call 1-883-PALACOS or visit www.heraeus-medical-usa.com

Pin, Prep, Implant

Simplify the implant process and reduce the number of steps with the INHANCE Shoulder System One Step Prep Glenoid from DePuy Synthes.

• The company says One Step Prep Glenoid reduces the number of surgical steps by up to 59% over traditional pegged glenoids.
• The INHANCE Shoulder System circular glenoid shape is designed to simplify implant insertion with an attached inserter, compared with an oval or pear-shaped glenoid.
• One Step Prep Reamers prepare all glenoid features on the same axis, as opposed to other systems that require sequential step preparation, according DePuy Synthes.

For more information, visit http://www.jnjmedtech.com/en-US/product/inhance-shoulder-system

The Power of One Platform in the ASC

Looking for smarter, more efficient, orthopedic surgery solutions in your ASC? The CORI Surgical System from Smith+Nephew provides a range of procedural solutions for partial, total and revision knee arthroplasty and total hip arthroplasty (THA). Combine your skill with handheld robotics and digital surgery applications across a range of joint arthroplasty indications — all on one platform that includes:

• Image-free smart mapping and real-time gap assessments
• An ergonomic handpiece with burr designs delivering twice the cutting volume for a more efficient workflow
• Compatibility with Smith+Nephew total, partial and revision knee systems and with implants and approaches for THA.

For more information, visit www.smith-nephew.com OSM