In cases where patients are at risk of Malignant Hyperthermia (MH) and require general anesthesia, the use of a total intravenous anesthetic (TIVA) technique is recommended as a safer alternative to potent inhalational agents. Ideally, an anesthesia machine designated solely for malignant hyperthermia cases (one that has not been used to administer volatile anesthetics) would be used. However, this option is not always available. Since residual inhalational agents in an anesthetic machine could potentially trigger an MH reaction, it's crucial to prepare the machine properly to minimize this risk. Studies aiming to eliminate potent inhalational anesthetics from machines have generally targeted a maximum safe concentration of 5 parts per million (ppm), which is considered to provide a significant safety margin. Flushing the machine with 100% oxygen can eliminate trace amounts of inhalational agents, although the time needed for this process varies depending on the specific anesthetic machine. While the required flush times for several machines have been documented, the responsibility for providing this information ideally lies with the machine's manufacturer.
Activated charcoal, a highly porous carbon material, adsorbs volatile anesthetic agents, reducing their concentration quickly and effectively. The use of activated charcoal filters (ACFs) has emerged as an alternative method to prevent the administration of trace quantities of inhalational agents to MH-susceptible patients. The recommendation is to store ACFs in areas where volatile anesthetic agents are used, as they play a crucial role in both preparing for MH-susceptible patients and managing on-table MH reactions.
