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Prompt administration of intravenous (i.v.) dantrolene sodium (DS) is the primary determinant of successful treatment of malignant hyperthermia (MH) syndrome. Because DS has a long reconstitution time for use in treating an MH crisis, we evaluated an alternative technique for hastening the reconstitution. Simulating real-world conditions, with equipment common to the operating room environment, we conducted a randomized, controlled, single-blind study dividing 16 DS vials into 2 equal groups: warm (41 degrees C) and ambient temperature (22 degrees C). With an i.. fluid warmer at 41 degrees C, primed with a 1-L bag of preservative-free sterile water, attached to a 60-mL syringe via a 3-way stopcock, we aspirated and injected the diluent directly into each DS vial. The Icarus effect was clearly demonstrated: warmed diluent vs ambient temperature hastened the reconstitution time for DS. The mean time to particulate-free DS solution suitable for i.v. injection with the warm diluent was 58.88 seconds compared with 93.87 seconds for the ambient temperature group (P <.001). A practical method using a reliable and safe warming device readily available to anesthetists and ubiquitous to the operating room environment speeds the time to administration of DS ultimately reducing morbidity and mortality associated with MH. [ABSTRACT FROM AUTHOR]

Background: Vancomycin has only rarely been implicated as a cause of thrombocytopenia, and there is only limited evidence that this complication is caused by immune mechanisms. We conducted a study to determine whether thrombocytopenia is caused by vancomycin-dependent antibodies in patients being treated with vancomycin.Methods: We identified and characterized vancomycin-dependent, platelet-reactive antibodies in patients who had been referred for testing during a 5-year period because of a clinical suspicion of vancomycin-induced thrombocytopenia. We obtained clinical information about the patients from their referring physicians.Results: Drug-dependent, platelet-reactive antibodies of the IgG class, the IgM class, or both were identified in 34 patients, and clinical follow-up information was obtained from 29 of these patients. The mean nadir platelet count in these patients was 13,600 per cubic millimeter, and severe bleeding occurred in 10 patients (34%). Platelet levels returned to baseline in all 26 surviving patients after vancomycin was stopped. In 15 patients, the drug was continued for 1 to 14 days while other possible causes of thrombocytopenia were investigated. Vancomycin-dependent antibodies were not found in 25 patients who had been given vancomycin and in whom thrombocytopenia did not develop.Conclusions: Severe bleeding can occur in patients with vancomycin-induced immune thrombocytopenia. The detection of vancomycin-dependent antiplatelet antibodies in patients receiving the antibiotic in whom thrombocytopenia develops, and the absence of antibodies in patients given the drug in whom platelet counts remain stable, indicate that these antibodies are the cause of the thrombocytopenia. [ABSTRACT FROM AUTHOR]