A 24-year-old woman with a family history of malignant hyperthermia requires general anaesthesia for laparoscopic cholecystectomy. The safest anaesthetic technique would include which of the following?

• A Thiopentone induction with isoflurane maintenance
• B Propofol induction with sevoflurane maintenance and vecuronium relaxation
• C Propofol induction with desflurane maintenance and rocuronium relaxation
• D Propofol induction with fentanyl and propofol maintenance, rocuronium relaxation ✓

Explanation

Malignant hyperthermia is triggered by all halogenated volatile agents and succinylcholine. A total intravenous anaesthesia technique using propofol with opioid-based analgesia and a non-depolarising relaxant such as rocuronium avoids both trigger classes completely. Sevoflurane, desflurane and isoflurane are potent MH triggers despite their smooth cardiovascular profiles. Nitrous oxide, ketamine, local anaesthetics and non-depolarising muscle relaxants are considered safe in susceptible patients.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.