Vegas Team Implements Innovative Malignant Hyperthermia Simulation Training in Operating Room - VHA SimLEARN
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Vegas Team Implements Innovative Malignant Hyperthermia Simulation Training in Operating Room

By Kimberly A. Macasieb, MSN, RN, CNL, CNOR
Operating Room Staff Nurse
VA Southern Nevada Healthcare System

LAS VEGAS – Staff at the VA Southern Nevada Healthcare System (VASNHS) recently teamed up to create a realistic simulation designed for the post anesthesia care unit or PACU environment focusing on recognizing malignant hyperthermia (MH) signs and symptoms in a standardized patient. Training for MH emergencies is now in the VASNHS Operating room (OR) where staff began focusing on training for low-volume high-risk emergency situations such as MH by participating in a simulated MH crisis. This training allows for hands-on practice, as well as to practice clinical procedures, communication and teamwork in a realistic, high-tension scenario.

Malignant hyperthermia (MH) is a potentially fatal, inherited disorder usually associated with the administration of certain general anesthetics and/or the drug succinylcholine. MH results in an acceleration of metabolism in skeletal muscle. The incidence of MH in adults is approximately 1 in 100,000 surgeries, and severe complications such as cardiac arrest, brain damage, internal bleeding or failure of other body systems may occur if the crisis is not treated promptly. Death, due to a secondary cardiovascular collapse, can result (MHAUS, 2019).

VASNHS OR MH simulation training incorporates interdisciplinary collaboration between OR registered nurse education and training champions, the facility simulation coordinator, anesthesia providers, pharmacy, anesthesia technicians, circulating RNs and surgical technicians. The 2019 MH simulation training was unannounced and took place six weeks after the didactic training to assess staff retention of learning.

Names were pulled randomly to assign roles of RN circulator #1, RN circulator #2, surgical technician and runner. These four staff members were briefed outside of the OR on the situation: a patient undergoing a laparoscopic appendectomy; including patient background and baseline vital signs. Upon entering the OR, the team found a standardized patient with a simulated IV draped on the operating table with staff acting as the anesthesia provider, surgeon and resident ready to begin the procedure. The circulating RN performed the time-out, and the procedure began.

A few minutes into the procedure, the anesthesia provider simulated issues ventilating the patient and the MH crisis began to unfold. The following objectives needed to be met by staff members before the simulation ended:

  • Recognize the signs and symptoms of an MH crisis
  • Call for help
  • Get MH Cart
  • Administer dantrolene
  • Pack patient in ice
  • Call MH hotline

The MH cart was stocked with simulated vials of dantrolene that could be reconstituted and administered through an IV. This medication is orange in color when reconstituted, so it is important that staff are familiar with this, so they aren’t caught off-guard during a true crisis. Another staff member acted as the “MH Hotline Operator,” allowing staff to place a call as they would during an MH crisis. Previously, this simulation was performed with a mannequin.

Although OR staff were initially hesitant to be “put on the spot” during the simulation, they excelled under pressure, met the objectives, and administered dantrolene within an average of 8.6 minutes from the onset of symptoms. All participants that completed the evaluation “strongly agreed” that the simulation will be applied to their clinical practice. VASNHS OR staff are better prepared to handle an MH crisis because of simulation training.


Malignant Hyperthermia Association of the United States (2019). What is MH / MHAUS. Retrieved from