Which agents raise concern for malignant hyperthermia in the context of sedation?

Which agents raise concern for malignant hyperthermia in the context of sedation?

• A. Inhaled volatile anesthetics and depolarizing neuromuscular blockers
• B. Propofol and ketamine are not malignant hyperthermia triggers
• C. Non-triggering agents include local anesthetics only
• D. Benzodiazepines are the primary triggers of MH

Answer: (A)

Malignant hyperthermia is a genetic reaction of skeletal muscle to certain anesthetic drugs, causing a dangerous surge in metabolic activity. The drugs that raise concern are inhaled volatile anesthetics (such as sevoflurane, isoflurane, desflurane, and others) and depolarizing neuromuscular blockers (notably succinylcholine). When these agents are used, a defect in calcium regulation inside muscle cells can trigger a rapid, uncontrolled release of calcium, leading to muscle rigidity, excessive heat production, acidosis, hyperkalemia, rhabdomyolysis, and potentially life-threatening complications if not treated promptly with dantrolene and supportive care. In sedation contexts, this means avoiding these triggers when possible and opting for non-triggering alternatives. Non-triggering options include propofol and ketamine for sedation, benzodiazepines, and local anesthetics. If anesthesia is necessary in someone with MH susceptibility, use non-triggering agents and have dantrolene available as treatment.

Malignant hyperthermia is a genetic reaction of skeletal muscle to certain anesthetic drugs, causing a dangerous surge in metabolic activity. The drugs that raise concern are inhaled volatile anesthetics (such as sevoflurane, isoflurane, desflurane, and others) and depolarizing neuromuscular blockers (notably succinylcholine). When these agents are used, a defect in calcium regulation inside muscle cells can trigger a rapid, uncontrolled release of calcium, leading to muscle rigidity, excessive heat production, acidosis, hyperkalemia, rhabdomyolysis, and potentially life-threatening complications if not treated promptly with dantrolene and supportive care.

In sedation contexts, this means avoiding these triggers when possible and opting for non-triggering alternatives. Non-triggering options include propofol and ketamine for sedation, benzodiazepines, and local anesthetics. If anesthesia is necessary in someone with MH susceptibility, use non-triggering agents and have dantrolene available as treatment.