Which of the following is NOT a trigger for malignant hyperthermia?

• A. Sevoflurane
• B. Propofol
• C. Succinylcholine
• D. Desflurane

Answer: (B)

Malignant hyperthermia is triggered by agents that rapidly disrupt calcium handling in skeletal muscle. The classic triggers are volatile inhaled anesthetics and the depolarizing muscle relaxant. Propofol, on the other hand, is an IV nonvolatile anesthetic that does not activate the abnormal calcium release pathway in susceptible individuals, so it does not initiate the MH crisis. That’s why propofol is not a trigger and can be used safely in MH-susceptible patients for anesthesia.

The other agents listed are triggers: volatile anesthetics like sevoflurane and desflurane can provoke an MH reaction, and succinylcholine, a depolarizing neuromuscular blocker, also triggers the cascade.