Anaes · Critical incidents
Malignant hyperthermia
Also known as MH · MH crisis · Malignant hyperpyrexia · Anaesthesia-induced rhabdomyolysis · Dantrolene
Exam-exhaustive malignant hyperthermia: RYR1 calcium storm, absolute trigger list, early ETCO2/masseter signs, EMHG/MHAUS crisis bundle, exact dantrolene dosing, cooling and hyperkalaemia/DIC management, trigger-free technique, and family counselling with MH unit referral for ANZCA Final and equivalents.
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12 MCQs with explanations
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Meet the patient
A 24-year-old man having a knee arthroscopy is forty minutes into a sevoflurane anaesthetic when the end-tidal carbon dioxide climbs from 4.5 to 9 kPa despite a doubling of the minute ventilation. His heart rate is 140, his jaw is tight after the suxamethonium you gave at induction, and the soda lime is warm. The temperature probe reads 38.4 degrees and is still rising.[1]
The two questions that decide his next ten minutes are the two that decide every hyperthermia crisis: is the carbon dioxide rising against ventilation? and has he been exposed to a trigger? Answer yes to both and you do not wait for a temperature — you open the dantrolene drawer now.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
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- [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