Causes
Malignant hyperthermia is most commonly due to volatile anesthetic gases, such as halothane, sevoflurane, desflurane, isoflurane, enflurane or the depolarizing muscle relaxants succinylcholine, decamethonium, and suxamethonium used primarily in general anesthesia. Other drugs that have been suspected of causing MH include ketamine, catecholamines, phenothiazines, and monoamine oxidase inhibitors. There are also few reports of MH being triggered by nitrous oxide administration. In rare cases, the biological stresses of physical exercise or heat may be the trigger.
Other anesthetic drugs are considered safe. These include local anesthetics (lidocaine, bupivicaine, mepivacaine), opiates (morphine, fentanyl), ketamine, barbiturates, nitrous oxide, propofol, etomidate, benzodiazepines.
The nondepolarizing muscle relaxants pancuronium, cisatracurium, atracurium, mivacurium, vecuronium and rocuronium also do not cause MH.
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