To the Editor:—
Dantrolene, an emergency resuscitation drug, should be sold in packaging that facilitates drug access. It is not. Each dantrolene vial is topped with a butyl rubber stopper encased in a crimped aluminum cap (fig. 1). Before reconstituting the drug, one must remove the sharp-edged cap center. This can be hazardous; the first author experienced a finger laceration while attempting bare-handed cap center removal during a malignant hyperthermia resuscitation.
Fig. 1. Dantrolene vial cap: (A) intact, or after cap center removal with (B) a car key or (C) the point of a ballpoint pen.
Fig. 1. Dantrolene vial cap: (A) intact, or after cap center removal with (B) a car key or (C) the point of a ballpoint pen.
To identify efficient, safe ways to remove the cap center, we obtained expired dantrolene vials (Dantrium®Intravenous; Procter & Gamble Pharmaceuticals, Cincinnati, OH) from City Avenue Hospital, Philadelphia, Pennsylvania. Cap centers were removed relatively easily using the point of a ballpoint pen, a hemostat, or a screwdriver. Tools too thick to insert under the edge of the cap center (e.g. , car keys) were effective but mangled the outer cap ring in the process. Of course, reconstitution would be faster and easier if Procter & Gamble packaged dantrolene (average wholesale price, $65.87) with a convenient flip-top lid, such as that atop 5-ml vials of 0.9% sodium chloride (Abbott Laboratories, North Chicago, IL; average wholesale price, $1.20).
Until Procter & Gamble improves dantrolene packaging, an anesthesia department might keep a safe, efficient cap center removal tool with the departmental dantrolene. Alternatively, the pharmacy department could remove the cap centers prophylactically and cover the stopper with sterile tape. Dantrolene dissolution is notoriously difficult; the packaging should not make the job more dangerous.
