Which of the following correctly lists the triggering agents for malignant hyperthermia?

• A. Halogenated volatile anesthetics and depolarizing muscle relaxant succinylcholine
• B. Halogenated volatile anesthetics and nondepolarizing muscle relaxants
• C. Depolarizing muscle relaxant succinylcholine and opioids
• D. Nondepolarizing muscle relaxants and NSAIDs

Answer: (A)

Malignant hyperthermia is a genetic disruption of skeletal muscle calcium regulation that is triggered by certain anesthetic agents. The classic triggers are halogenated volatile anesthetics (the inhaled, halogenated anesthetics) and the depolarizing neuromuscular blocker succinylcholine. In susceptible individuals, these triggers cause uncontrolled calcium release from the sarcoplasmic reticulum via the ryanodine receptor, leading to a rapid rise in metabolic activity, heat production, muscle rigidity, acidosis, and other crisis features.

Therefore, pairing halogenated volatile anesthetics with succinylcholine best describes the triggering agents. Nondepolarizing muscle relaxants, opioids, and NSAIDs are not known triggers for malignant hyperthermia, so they don’t fit the mechanism.