Abstract
(Anesthesiology. 2018;129:249–259) Understanding the cost-benefit trade-off of maintaining a malignant hyperthermia (MH) cart has important policy implications. The Malignant Hyperthermia Association of the United States recommends that operating room areas have dantrolene immediately available for administration (within 10 min). One approach to dantrolene availability is an MH cart, stocked with dantrolene, other drugs, and supplies, which is cost-effective in areas with a substantial number of general anesthetics. However, labor and delivery units rarely use MH—triggering drugs. If you consider a hospital with 6000 deliveries in a year with a 30% cesarean delivery rate and a 5% general anesthesia rate, general anesthesia will be used <100 times in 1 year. Such a low incidence prompts the question of whether the standard proposed is necessary for maternity units, because, to meet this standard, many maternity units should have their own MH cart. One may question if the resources used to maintain an MH cart may be better utilized on other initiatives that may have a more significant impact on maternal morbidity or mortality (such as a difficult airway cart).
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