Which combination of agents is most closely associated with malignant hyperthermia triggers?

Which combination of agents is most closely associated with malignant hyperthermia triggers?

• A. Ketamine and nitrous oxide
• B. Propofol
• C. Volatile inhaled anesthetics and succinylcholine
• D. Etomidate

Answer: (C)

Malignant hyperthermia is precipitated by certain anesthetic drugs that disrupt calcium handling in skeletal muscle. The classic triggers are volatile inhaled anesthetics and the depolarizing muscle relaxant succinylcholine. When exposed to these agents, the ryanodine receptor in the muscle’s sarcoplasmic reticulum can release calcium uncontrollably, sparking a rapid, severe hypermetabolic state with increased carbon dioxide production, heat, acidosis, tachycardia, muscle rigidity, and potential hyperkalemia. Other commonly used anesthetic drugs such as propofol, etomidate, and ketamine (often with nitrous oxide) are not associated with triggering malignant hyperthermia, which is why they’re not linked to MH onset. If MH is suspected, the key steps are to stop triggering agents, provide 100% oxygen, cool the patient, and administer dantrolene.

Malignant hyperthermia is precipitated by certain anesthetic drugs that disrupt calcium handling in skeletal muscle. The classic triggers are volatile inhaled anesthetics and the depolarizing muscle relaxant succinylcholine. When exposed to these agents, the ryanodine receptor in the muscle’s sarcoplasmic reticulum can release calcium uncontrollably, sparking a rapid, severe hypermetabolic state with increased carbon dioxide production, heat, acidosis, tachycardia, muscle rigidity, and potential hyperkalemia. Other commonly used anesthetic drugs such as propofol, etomidate, and ketamine (often with nitrous oxide) are not associated with triggering malignant hyperthermia, which is why they’re not linked to MH onset. If MH is suspected, the key steps are to stop triggering agents, provide 100% oxygen, cool the patient, and administer dantrolene.