Succinylcholine Use and Dantrolene Availability: Reply,
Marilyn Green Larach, M.D., F.A.A.P.; Thomas T. Klumpner, M.D.; Barbara W. Brandom, M.D., M.S.; Michelle T. Vaughn, M.P.H.; Kumar G. Belani, M.B.B.S., M.S., F.A.A.P.; et al Andrew Herlich, D.M.D., M.D., F.A.A.P., F.A.S.A.; Tae W. Kim, M.D., M.E.H.P., F.A.S.A.; Janine Limoncelli, M.D.; Sheila Riazi, M.Sc., M.D., FRCPC; Erica L. Sivak, M.D.; John Capacchione, M.D.; Darlene Mashman, M.D.
 Author Notes
The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States, University of Florida College of Medicine, Gainesville, Florida (M.G.L.). mlarach@gmail.com
Anesthesiology Newly Published on August 27, 2019. doi:10.1097/ALN.0000000000002950

We thank Drs. Joshi, Desai, Valedon, and Gayer for their interest in our database analyses and systematic literature review of succinylcholine use and dantrolene availability for malignant hyperthermia treatment.1  Joshi et al. state that our analyses do not include data from Class B ambulatory care facilities. The American Association for Accreditation of Ambulatory Surgery Facilities (Gurnee, Illinois) defines Class B facilities as those that allow minimally or moderately invasive surgical, endoscopic and/or pain management procedures under moderate sedation with intravenous sedation, and/or parenteral sedation, and/or field and peripheral nerve blocks, and/or dissociative drugs excluding propofol.2  Because the Multicenter Perioperative Outcomes Group (Ann Arbor, Michigan) uses different classifications for its participating institutions, we do not know how many of the 24 freestanding ambulatory surgery centers captured in our study also might have been Class B facilities.