Why were procainamide and mannitol taken off the list of drugs to stock for an MH episode?

Procainamide, a secondary drug used in the treatment of arrhythmias, is not readily available, and people are generally not familiar with its use. Lidocaine is a primary drug that all physicians have used for years; however, it was previously thought that lidocaine might aggravate MH. Based on a review of the literature and consensus of MH experts, we have determined that it does not, and thus, our MH experts have approved its use during an MH episode. Mannitol has been taken off the list of drugs because dantrolene (Dantrium^® IV) has 3 grams of mannitol included in each vial. The patient will receive 0.375gm/kg mannitol when given 2.5 mg/kg dantrolene.

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