Anaes SAQs · Critical incidents & patient safety
Rising end-tidal carbon dioxide on sevoflurane — the MH crisis bundle
Final SAQ on malignant hyperthermia: the sentinel end-tidal carbon dioxide, the absolute trigger list, the dantrolene dosing spine, cooling and hyperkalaemia management, and the trigger-free plan with family referral.
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Prompt
Forty minutes into a sevoflurane anaesthetic, the end-tidal carbon dioxide climbs from 4.5 to 9 kPa despite a doubling of the minute ventilation. The heart rate is 140, the jaw was tight after suxamethonium at induction, and the temperature reads 38.4 degrees and rising. Outline your diagnosis and crisis management.
Question
Forty minutes into a sevoflurane anaesthetic, the end-tidal carbon dioxide climbs from 4.5 to 9 kPa despite a doubling of the minute ventilation. The heart rate is 140, the jaw was tight after suxamethonium at induction, and the temperature reads 38.4 degrees and rising. Outline your diagnosis and crisis management[1][2].
References5ShowHide
- [1]Glahn KPE, Girard T, Hellblom A, et al. Recognition and management of a malignant hyperthermia crisis: updated 2024 guideline from the European Malignant Hyperthermia Group Br J Anaesth, 2025.PMID 39482150
- [2]Larach MG, Gronert GA, Allen GC, et al. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006 Anesth Analg, 2010.PMID 20081135
- [3]Rosenberg H, Pollock N, Schiemann A, et al. Malignant hyperthermia: a review Orphanet J Rare Dis, 2015.PMID 26238698
- [4]Krause T, Gerbershagen MU, Fiege M, et al. Dantrolene--a review of its pharmacology, therapeutic use and new developments Anaesthesia, 2004.PMID 15023108
- [5]Rüffert H, Bastian B, Bendixen D, et al. Consensus guidelines on perioperative management of malignant hyperthermia suspected or susceptible patients from the European Malignant Hyperthermia Group Br J Anaesth, 2021.PMID 33131754