How should the anesthesia machine be prepared before surgery for an MHS patient?
Ensure that anesthesia vaporizers are disabled by removing or taping in the “OFF” position. Flow 10L/min 02 through circuit for at least 20 minutes. During this time a disposable, unused breathing bag should be attached to the Y-piece of the circle system and the ventilator set to inflate the bag periodically. Use a new or disposable breathing circuit. The expired gas analyzer will indicate absence of volatile agents in the anesthesia circuit. Changing the CO2 absorbent (soda lime or baralyme) is not recommended if these procedures are followed. However, newer anesthesia machines such as the Drager Fabius may require up to 60 minutes of preparation. Check with the manufacturer of the machine for suggested washout procedure. A summary of the recommendations for the Drager Fabius machine is found in the following article: Gunter, JB et al. Preparation of the Drager Fabius Machine for the Malignant Hyperthermia Susceptible Patient. [Anesthesia and Analgesia; 2008: 107; 1936-1945.] This ar
