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Malignant Hyperthermiais a pharmacogenetic disease of skeletal muscle that may precipitate a potentially fatal sequence of metabolic responses in the presence of triggering anesthetics. The primary triggers for MH are - Inhalational Anesthetics and Succinylcholine.
Incidence estimated at 1:10,000 and 1: 150,000. Etiology involves the uncontrollable release of intramyoplasmic calcium (Ca2+) that results in sustained muscle contractures, which in return produces a hypermetabolic response. The hypermetabolic response manifests as hypercarbia, hyperthermia, tachycardia, and if not treated early, a mixed metabolic and respiratory acidosis, muscle rigidity, severe rhabdomyolysis, circulatory shock and possibly death. NEW MH POLICY Updated FEB 2019:
(incorporates Ryanodex - a new dantrolene formulation) |
Anesthesia Workstation Preparation for MH Susceptible Patients
The recommended instructions for clearing residual anesthetic gases from our Drager Apollo Workstation include:
OPTION 1
OPTION 2
If time is of the essence, "Vapor-Clean" Activated Charcoal Filters may be used to quickly sanitize and prepare the machine for a vapor free anesthetic. Filter is effective in keeping gas concentration below 5 ppm for up to 12 hrs with FGF of at least 3L/min.
Instructions can be downloaded here
Instructional Video (requires Flash)
OPTION 1
- Remove vaporizer or disable by taping in OFF position
- Attach a new breathing circuit and reservoir bag to the Y-piece of the circle system and set the ventilator to inflate the bag periodically.
- Run Oxygen FGF at 10L/min with ventilator running, tidal volume of 600ml, rate of 10 breaths/min (1:2) for up to 104 minutes. For Drager Apollo the recommendation is 90 minutes for Isoflurane, and 50 minutes for Sevoflurane
- Changing CO2 absorbent is recommended
- Once the machine has been flushed, replace the breathing circuit with a new Breathing Circuit prior to Leak Test per recommended procedure.
- Machine is then ready for use!
OPTION 2
If time is of the essence, "Vapor-Clean" Activated Charcoal Filters may be used to quickly sanitize and prepare the machine for a vapor free anesthetic. Filter is effective in keeping gas concentration below 5 ppm for up to 12 hrs with FGF of at least 3L/min.
- Procedure requires flushing machine at high flow (>10L/min) for 90 seconds prior to placing filters on BOTH the inspiratory and expiratory ports.
Instructions can be downloaded here
Instructional Video (requires Flash)
The Malignant Hyperthermia Cart
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The Cart is stored behind the Fish Bowl Nursing Desk in the F5 Main OR
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Clinical Presentation of MH
Management of Malignant Hyperthermia
