A patient’s family history suggests risk for malignant hyperthermia during anesthesia. Which statement best describes the safe approach?

• A. Anesthesia can be administered with minimal risks with precautions.
• B. As long as succinylcholine is not used, the reaction should not occur.
• C. Surgery must be performed under local anesthesia to prevent MH.
• D. Surgery will be delayed until genetic testing determines susceptibility.

Answer: (A)

When a family history suggests susceptibility to malignant hyperthermia, the safest approach is to plan for anesthesia with full precautions rather than delaying surgery or assuming no risk. Malignant hyperthermia is a pharmacogenetic reaction triggered by certain anesthetic drugs, most notably volatile inhaled agents and the depolarizing muscle relaxant. Because not all triggers are avoided by skipping succinylcholine, the patient must be managed as MH-susceptible with a prepared environment: use nontriggering anesthetics (such as total intravenous anesthesia with propofol, opioids, and nondepolarizing neuromuscular blockers), avoid volatile agents, keep dantrolene readily available, and have rigorous intraoperative monitoring (especially end-tidal CO2 and core temperature) with a plan for rapid treatment if signs develop.

In other words, you can proceed with anesthesia safely, but only if you take these precautions and are ready to treat an MH crisis. The idea that simply not using succinylcholine prevents MH is incorrect because other triggering agents can still cause a reaction. Delaying surgery for genetic testing isn’t practical or necessary, and local anesthesia doesn’t inherently eliminate risk if other medications or sedation are used.