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Malignant hyperthermia — FRCA Final MCQ

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EasyGeneral AnaesthesiaMalignant hyperthermiaFRCA Final

A 32-year-old man has volatile anaesthesia and suxamethonium for emergency wound exploration. Forty minutes later the end-tidal CO2 rises to 10 kPa despite increased ventilation, temperature is 39.4°C, heart rate is 145/min, and serum potassium is 6.3 mmol/L. What is the most appropriate management?

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Correct answer: E — Stop triggering agents and give intravenous dantrolene

The combination of rising CO2, hyperthermia, tachycardia and hyperkalaemia after volatile anaesthesia and suxamethonium is malignant hyperthermia. Immediate treatment is to stop triggers, change to a non-triggering anaesthetic, hyperventilate with oxygen, give dantrolene and treat hyperkalaemia/acidosis. Calcium is needed for cardioprotection in severe hyperkalaemia, but it is not definitive treatment. Creatine kinase confirmation is delayed and must not postpone resuscitation.

Reference: Association of Anaesthetists malignant hyperthermia guidance; BNF