Preparation of Anaesthetic Workstations for MH suspected or susceptible patients

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There are three options to prepare the workstation:

  1. A dedicated “vapour free” workstation only for trigger free anaesthesia may be used if such a machine is available. Otherwise an anaesthetic workstation needs to be prepared for the MH-susceptible patient.
  2. An anaesthetic workstation may be prepared by flushing (fig.1). This process will take some time and should be planned well ahead.
    We recommend removing the vaporizer and changing the anaesthetic breathing circuit (T-circuit, circle circuit, reservoir bag) and soda lime canister for uncontaminated equipment before flushing  
    (Strong recommendation, evidence level: 2-).
    The anaesthetic workstation should be flushed according to the manufacturer’s guidelines. These recommendations are very variable and may require flushing for two hours and beyond.
  3. Activated charcoal filters (ACFs) may be used (fig. 1). This method may be used if there is limited time.
    We recommend removing the vaporizer and changing the anaesthetic breathing circuit (T-circuit, circle circuit, reservoir bag) and soda lime canister for uncontaminated equipment before flushing for 90 sec with maximal oxygen flow.
    (Strong recommendation, evidence level: 2-).
    We suggest to place ACFs on both the inspiratory and expiratory limb of the breathing circuit.
    (weak recommendation, best practice statement) 
EMHG_Workstation_Preparation.png

Level of evidence

Adapted from SIGN

level 1+High quality meta-analyses, systematic reviews of RCT or RCTs with very low risk of bias
level 1-Meta-analyses, systematic reviews or RCTs with high risk of bias
level 2+systematic reviews of case control or cohort studies with low risk of bias
level 2-case control or cohort studies with high risk of bias, animal studies
level 3case reports, case series
level 4Expert opinion