NEW practice change regarding Malignant Hyperthermia (MH) setups.
Based on strong recommendations from Dr. Riazi (Director, UHN MH Investigation Unit) and recent literatures, the use of Activated Charcoal Filters (ACFs) will be implemented to achieve and maintain a trigger-free anesthetic (<5ppm) for all MH susceptible patients. The use of ACFs drastically reduces the flushing time to 90 seconds.
MH Setup Procedure
1. Turn off and remove anesthetic vaporizer. Tape off vaporizer if not removable.
2. Install new CO2 absorbent canister, breathing circuit, breathing bag, viral filters, and sample line.
3. Increase fresh gas flow to 15Lpm to flush the vapor from the anesthesia delivery system for 90 secs (only bag side required).
4. Install ACF filter on both inspiratory and expiratory port.
5. Maintain fresh gas flow >3lpm for duration of case.
Note:
· Filters are rated for 12 hours of continuous use for removing trace amount of volatile from the breathing system. If the patient is actively exhaling volatile, then filters needs to be changed after 60 mins.
· Filters have 2 years of shelf life in packaging. But performance cannot be guaranteed if left unused once the package is opened.
· Currently, filters are being rolled out at Bayview OR and Holland OR (available in the MH cart). There will be plans to expand to all other anesthetizing locations across the Bayview campus.
· MH policy CLS-0043 will require to be updated to reflect above setup procedure. In the meantime, please follow above steps for MH setup.
·In-service for the filters is available on May 9th 11am-2pm in the Anesthesia conference room.
Regards,
Philip Lau
Clinical and Professional Leader | Anesthesia Care Team
No Comments