Pfenninger E, Heiderich S, Klingler W
Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Deutschland.
Abteilung Neuroanästhesie, Universität Ulm im Bezirkskrankenhaus Günzburg, Günzburg, Deutschland.
Anaesthesist. 2017 Oct;66(10):773-781. doi: 10.1007/s00101-017-0335-z. Epub 2017 Jun 28.
A malignant hyperthermia (MH) crisis is a potentially fatal complication in anesthesia and intensive care units (ICU). Rapid administration and adequate dosage of dantrolene is the only known effective pharmacological and causal treatment of an MH crisis. International anesthesiology societies recommend an initial dose of 2.0-2.5 mg/kg body weight (BW). The necessary total dosage should be titrated up to 10 mg/kg BW depending on the effectiveness.
The goal of this study was an analysis of the stocking situation of dantrolene in Germany. A national survey was conducted amongst members of the German Society of Anaesthesia and Intensive Care (DGAI).
A questionnaire consisting of 19 items was posted online to all DGAI members from 2 September to 30 September 2015. The questionnaire dealt with characterization of the participants, the administration of triggering substances in the operating room and in the ICU of the respective hospitals. The main part covered the amount of stocked dantrolene, the place of storage and emergency availability of stocked dantrolene from elsewhere.
The questionnaire was posted online to 12,415 DGAI members with a response rate of 13.5% (n = 1673). The highest response rate was from 259 directors and heads of anesthesiology units representing 28.3%. In total 93,7% of participants use volatile anesthetics and 82,3% use succinylcholine. In the event of an MH-crisis 40.4% of participants have 36 or more vials of dantrolene available within 5 min, 27.4% have only 24 vials and 18.7% only have 12 vials. Of the anesthesiologists in outpatient surgery 70.6% have a dantrolene stock of less than 36 vials. In those cases with insufficient dantrolene stock, 35.5% of hospitals have no agreement with neighboring hospitals. In the ICU setting, 51.8% of responding participants indicated the use of volatile anesthetics, but only 25.7% stock dantrolene in the ICU. For succinylcholine, 77.3% stated using the drug in the ICU, and 26.0% have a dantrolene stock in the ICU.
Almost all anesthesiologists participating in the online survey use volatile anesthethics and/or succinylcholine. Whereas almost all participants have access to dantrolene, more than half of the units have a stock of dantolene, which is less than that recommended by the DGAI. In the case of low dantrolene stock, only 61% of anesthesia departments have access to additional dantrolene within a time frame of 15min . The results of this online survey demonstrate that the stock of dantrolene may be insufficient in some German hospitals and anesthesiology practices.
恶性高热（MH）危象是麻醉和重症监护病房（ICU）中一种潜在的致命并发症。快速给药且剂量充足的丹曲林是已知唯一有效治疗MH危象的药物及病因治疗方法。国际麻醉学协会推荐初始剂量为2.0 - 2.5毫克/千克体重（BW）。必要的总剂量应根据疗效滴定至10毫克/千克体重。
本研究的目的是分析德国丹曲林的储备情况。在德国麻醉与重症监护学会（DGAI）成员中进行了一项全国性调查。
2015年9月2日至9月30日，向所有DGAI成员在线发布了一份包含19项内容的问卷。问卷涉及参与者的特征、各自医院手术室和ICU中触发物质的使用情况。主要部分涵盖丹曲林的储备量、储存地点以及从其他地方紧急获取储备丹曲林的情况。
问卷在线发布给了12415名DGAI成员，回复率为13.5%（n = 1673）。回复率最高的是259名麻醉科主任和负责人，占28.3%。共有93.7%的参与者使用挥发性麻醉剂，82.3%使用琥珀酰胆碱。在发生MH危象时，40.4%的参与者在5分钟内有36瓶或更多的丹曲林可用，27.4%仅有24瓶，18.7%仅有12瓶。门诊手术的麻醉医生中，70.6%的丹曲林储备量少于36瓶。在丹曲林储备不足的情况下，35.5%的医院与邻近医院没有协议。在ICU环境中，51.8%的回复参与者表示使用挥发性麻醉剂，但只有25.7%在ICU储备丹曲林。对于琥珀酰胆碱，77.3%表示在ICU使用该药物，但26.0%在ICU储备有丹曲林。
几乎所有参与在线调查的麻醉医生都使用挥发性麻醉剂和/或琥珀酰胆碱。虽然几乎所有参与者都能获取丹曲林，但超过一半的科室丹曲林储备量低于DGAI推荐量。在丹曲林储备量低的情况下，只有61%的麻醉科在15分钟内能够获取额外的丹曲林。这项在线调查结果表明，德国一些医院和麻醉科的丹曲林储备可能不足。
