Anaes Vivas · Critical incidents & patient safety
Rising carbon dioxide on a volatile — MH viva
A clinical viva on malignant hyperthermia: the sentinel capnograph sign, the absolute trigger list, dantrolene dosing and logistics, the calcium-channel-blocker prohibition, and unit referral with trigger-free planning.
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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. Talk me through your diagnosis, your dantrolene plan with doses, and the follow-up for the patient and family.
Stimulus
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. Talk me through your diagnosis, your dantrolene plan with doses, and the follow-up for the patient and family[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