You are assisting the surgeon perform resection of the mass shown being retracted

You are assisting the surgeon perform resection of the mass shown being retracted. The surgery is done under general anesthesia. Ten minutes into the procedure while retracting the mass to identify the nerve, you note the muscle shown in the image is tense and under intense spasm. What is the next step in the management of this patient?

a. Ask anesthesiology for more neuromuscular relaxation

b. Inject lidocaine into the muscle

c. Check for injury to the facial nerve

d. Pour ice slush on to the surgical field

e. Change to a new anesthesia machine and complete surgery under IV anesthesia

f. Administer Baclofen

  1. Malignant hyperthermia (MH) is a life-threatening, rare, inherited skeletal muscle disorder with an incidence during anesthesia ranging from 1 : 10,000 to 250,000.

  2. The clinical presentation of MH has hypermetabolic features that are triggered by the depolarizing muscle relaxant (succinylcholine) and potent inhalation anesthetics and is related to the uncontrolled release of intercellular calcium from the skeletal muscle sarcoplasmic reticulum.

  3. It results in an increase in heart rate, core body temperature, and end-tidal CO2 (ETCO2), tachypnea, and acidosis.

  4. An additional common sign in patients who received succinylcholine is masseter muscle rigidity. Masseter muscle rigidity (MMR) is an early indicator of malignant hyperthermia in patients of all ages, especially in pediatric patients