Preparing Known or Suspected Cases

Any patient who is known to have MH, or is suspected of having MH, should be scheduled to be the first case on an elective list.

The main principle of management of these patients is that they are not exposed to sufficient concentrations of triggering agents to risk the development of an MH reaction. MH is not an allergy and trace amounts of triggering agents will not be sufficient to cause a reaction.

There are several publications that describe procedures for eliminating volatile anaesthetics from anaesthetic machines and workstations. The anaesthetic workstation manufacturer should also be able to advise on a suitable protocol. All of these protocols work on the basis that a concentration of volatile anaesthetic < 5 ppm is safe, although there is probably a greater margin of safety than this.

We recommend that every department of anaesthesia acquires activated charcoal filters which can be applied to inspiratory and expiratory limbs of the breathing circuit and, when used according to manufacturer’s instructions, will enable the safe use of anaesthetic work stations that have previously been used with MH triggering agents.

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