1Give another succinylcholine dose, continue sevoflurane, and treat tachycardia with a beta blocker.
2Stop triggers, call for help, use 100% oxygen, give IV dantrolene 2.5 mg/kg, and treat hyperkalemia, acidosis, and heat.✓ Correct answer
3Increase volatile anesthesia, administer acetaminophen, and wait for the temperature to fall before giving dantrolene.
4Switch to another volatile anesthetic and use surface cooling as the primary treatment for muscle rigidity.
Explanation
Malignant hyperthermia is a hypermetabolic emergency triggered by succinylcholine or volatile anesthetics. The team should stop triggering agents, call for assistance, deliver 100% oxygen with hyperventilation, and give IV dantrolene at an initial dose of 2.5 mg/kg with repeat dosing as required. Hyperkalemia, acidosis, dysrhythmias, renal injury, and hyperthermia also require active treatment. Antipyretics or cooling do not replace dantrolene and trigger removal.
Clinical reasoning Uncontrolled calcium release in skeletal muscle drives carbon dioxide production, rigidity, acidosis, potassium release, and heat. A rising end-tidal carbon dioxide can precede marked temperature elevation.
Decision rule Suspect malignant hyperthermia when hypercarbia and rigidity follow a trigger; stop the trigger, use 100% oxygen, administer dantrolene, and correct metabolic complications.
Scenario After succinylcholine and sevoflurane, a surgical client develops rapidly rising end-tidal carbon dioxide, generalized rigidity, tachycardia, hyperkalemia, and hyperthermia.
Malignant hyperthermia — A life-threatening inherited hypermetabolic response to triggering anesthetics caused by excessive skeletal-muscle calcium release.
Dantrolene — The specific treatment for malignant hyperthermia that reduces calcium release from skeletal-muscle sarcoplasmic reticulum.