Preparation of modern anesthesia workstations for malignant hyperthermia-susceptible patients: a review of past and present practice

Abstract

Patients with malignant hyperthermia experience an exaggerated metabolic response when exposed to volatile anesthetic gases and succinylcholine. The minimum concentration of anesthetic gas needed to trigger a malignant hyperthermia crisis in humans is unknown and may remain so because of the inherent risks associated with studying the complex nature of this rare and lethal genetic disorder. The Malignant Hyperthermia Association of the United States provides specific instructions on purging anesthesia machines of volatile agents to reduce the risk of exposure. However, these recommendations were developed from studies of older generation machines. Modern anesthesia workstations are more complex and contain more gas absorbing materials. A review of the literature found the current guidelines inadequate to prepare newer generation workstations, which require more time for purging anesthetic gases, autoclaving or replacement of parts, and modifications to the gas delivery system. Protocols must be developed to prepare newer generation anesthesia machines.