A 48-year-old male with a history of malignant hyperthermia (MH) susceptibility is scheduled for elective knee arthroscopy. Which of the following is the MOST appropriate anesthetic technique to minimize the risk of MH crisis?

Explanation

## Malignant Hyperthermia (MH) and Safe Anesthetic Technique **Key Point:** Patients with MH susceptibility must AVOID all known triggering agents: volatile anesthetics (sevoflurane, isoflurane, desflurane) and depolarizing muscle relaxants (succinylcholine). **Safe Anesthetic Approach:** - **Total Intravenous Anesthesia (TIVA)** using propofol and remifentanil is the gold standard for MH-susceptible patients. - Propofol is a non-triggering induction and maintenance agent. - Remifentanil provides analgesia without triggering MH. - Non-depolarizing muscle relaxants (rocuronium, vecuronium, atracurium) are safe alternatives if neuromuscular blockade is required. **Clinical Pearl:** The combination of TIVA + regional anesthesia (when feasible) provides the safest profile. If general anesthesia is necessary, TIVA alone is preferred over volatile anesthetics in MH-susceptible patients. **High-Yield:** MH triggers = **Volatile anesthetics + Succinylcholine**. Everything else (propofol, opioids, benzodiazepines, non-depolarizing agents, nitrous oxide) is safe.