Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:

  1. Read the article by Burkman et al.  entitled “Analysis of the clinical variables associated with recrudescence after malignant hyperthermia reactions” on page 901 and the accompanying editorial by Hopkins entitled “Recrudescence of malignant hyperthermia” on page 893 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: http://www.asahq.org/journal-cme. Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.

The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education programs for physicians.

The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Purpose:  The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.

Target Audience:  Physicians and other medical professionals whose medical specialty is the practice of anesthesia.

Learning Objectives:  After reading this article, participants should have a better understanding of the pathophysiology of malignant hyperthermia.

Authors – James M. Burkman, M.D., Karen L. Posner, Ph.D., and Karen B. Domino, M.D., M.P.H.

Grants or research support:  None

Consultantships or honoraria:  None

The article authored by Drs. Burkman, Posner, and Domino was supported solely from institutional and/or departmental sources.

Authors – Philip M. Hopkins, M.B., B.S., M.D., F.R.C.A.

Grants or research support:  None

Consultantships or honoraria:  None

The article authored by Dr. Hopkins was supported solely from institutional and/or departmental sources.

Question Writers – Peter L. Bailey, M.D., and Leslie C. Jameson, M.D.

Drs. Bailey and Jameson have no grants, research support, or consultant positions, nor do they receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.

Based on the article by Burkman et al.  entitled “Analysis of the clinical variables associated with recrudescence after malignant hyperthermia reactions” and its accompanying editorial by Hopkins entitled “Recrudescence of malignant hyperthermia” in the May issue of Anesthesiology, choose the one correct answer for each question:

1. Which of the following statements about the cause of malignant hyperthermia (MH) is most  likely true?

A. MH occurs as the result of decreased release of Ca++from the sarcoplasmic reticulum.

B. All patients susceptible to MH have an identified ryanodine receptor abnormality.

C. All patients susceptible to MH have an identified dihydropyridine receptor abnormality.

D. The genetic mutation pattern found for MH varies among countries.

2. Which of the following statements about identifying and classifying cases of malignant hyperthermia (MH) is most  likely true?

A. The National Institutes of Health maintains a database of reported MH cases.

B. The Adverse Metabolic Reaction to Anesthesia report uses a clinical grading system to assess the likelihood of MH in a given patient.

C. Contracture testing of a muscle biopsy specimen has no role in the classification of MH cases.

D. Mandatory reporting to the Food and Drug Administration is required for any suspected MH case.

3. Which of the following statements about recrudescence of malignant hyperthermia (MH) is most  likely true?

A. Recrudescence occurs in approximately 20% of patients initially treated for MH.

B. Recrudescence is more likely to occur after a sevoflurane anesthetic.

C. Recrudescence usually occurs more than 18 h after the initial event.

D. Recrudescence is more likely in older patients.

4. Which factor is most  likely associated with the recrudescence of malignant hyperthermia (MH)?

A. Muscular body habitus

B. Previous general anesthetic

C. Male sex

D. Shorter time between induction of anesthesia and MH reaction

5. When comparing the postoperative outcomes of patients with recrudescence to patients without recrudescence, which statement is most  likely true?

A. Hepatic dysfunction was more likely in patients with recrudescence.

B. There were more pulmonary complications in patients without recrudescence.

C. Cognitive dysfunction occurred more frequently in patients with recrudescence.

D. Disseminated intravascular coagulation occurred in more than 50% of patients in both groups.

6. Which of the following clinical signs was most  likely to be associated with recrudescence?

A. Clinical grading score below 20

B. Total dantrolene dose less than 2.5 mg/kg

C. Unexplained postoperative temperature increase above 38.8°C

D. Use of succinylcholine