Vapor-Clean Filters

[Noyac]

Are any of you familiar with Vapor-Clean filters for MH pts? Are they worth carrying? We usually get enough forewarning when an MH pt is coming. But I did have one in the middle of the night a few year back.

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[IlDestriero]

We use them for our MH patients. I don't know how much they cost though.


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Il Destriero

 

[urge]

We use them. Flushing the machine doesn't really work so well. You can still smell gas 30 min later.

 

[BLADEMDA]

I've used them several times. They are $35-$50 per set. I highly recommend them.

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[partydoc]

We have em. Used them a couple of times. Nice bc you can set em up quick

 

[Planktonmd]

Why is there a Nazi flag in the background of that guy's picture?

 

[sevoflurane]

Used it today for an MH patient. The package insert states 90 seconds.

 

[dhb]

How often do you get MH patients?

I've never seen one.

 

[BLADEMDA]

How often do you get MH patients?

I've never seen one.

I've had two in my career (actual MH patient) and about a dozen more who claim a close relative has MH where I decided to utilize precautions for the case.

 

[BLADEMDA]

How often do you get MH patients?

I've never seen one.

I've seen one so count your blessings. It's a LOT of work to treat MH.

 

[sevoflurane]

How often do you get MH patients?

I've never seen one.

Seen 2 real cases.

A lot of presumed cases.

My case from yesterday was a presumptive MH patient that required dantrolene on a previous GA.

For some reason a muscle bx was never acquired for definitive diagnosis. So she was treated as the real thing with a non triggering anesthetic.

 

[twoliter]

Seen 2 real cases.

A lot of presumed cases.

My case from yesterday was a presumptive MH patient that required dantrolene on a previous GA.

For some reason a muscle bx was never acquired for definitive diagnosis. So she was treated as the real thing with a non triggering anesthetic.

The sensitivity of the muscle biopsy is close to 100% (which means it's not 100%), so there are false positives. It's expensive (~$8-10,000). It can only be done in one of about 5 centers in North America. It requires another procedure/anesthetic (plus travel, lodging, etc. when applicable). Those are probably some of the reasons it wasn't done.

 

[deleted162650]

There is now a genetic test for MH as well

 

[drmwvr]

Anyone whose hospitals carry Ryanodex? It's the latest formulation of dantrolene without the mannitol, needs a fraction of diluent to reconstitute and is several times more concentrated so one or two vials are all that is needed for intitial rx. Also more expensive.

 

[twoliter]

There is now a genetic test for MH as well

But it's significantly less sensitive than the muscle biopsy (as low as 50%; they haven't identified all the genetic mutations associated with MH). Also, while it's less expensive, insurance is less likely to cover it. Certainly not a perfect test, but a lot easier on the patients.

 

[twoliter]

Anyone whose hospitals carry Ryanodex? It's the latest formulation of dantrolene without the mannitol, needs a fraction of diluent to reconstitute and is several times more concentrated so one or two vials are all that is needed for intitial rx. Also more expensive.

We're talking to the rep about it. It's certainly a much better drug, when you need it. But that's the problem, you rarely ever need it. The cost of conversion is about 2-3 times the cost of Dantrium. The best thing about it in my opinion is that the person whose sole job would normally be to mix the dantrolenw in an emergency can now be free to do something else. Which would be huge on nights/weekends with limited personnel.
Surprisingly, our pharmacist approached the pharmaceutical company to inquire about it. Pharmacy is usually the holdup due to the cost. But a lot of the bigger hospitals (especially pediatric ones) are converting.

 

[cchoukal]

We carry Vapor-Clean and Ryanodex, and, as a result of the Ryanodex, have adjusted our policy on MH to reassign nurses (who would otherwise be assigned to help dilute dantrolene) to other tasks. Pharmacy came to us with the change, actually; we didn't have to lobby them.

We have used the filters once, just to prepare a machine for an MH-susceptible patient, but I've never had a case of MH or had to use dantrolene or Ryanodex.