Technical corrections for Malignant Hyperthermia (MH) standards were released July 14, 2025. Some of the standard language has been updated, and QUAD A wanted to provide additional interpretive guidance for complete understanding of these standards.
The applicability of these standards can often be confusing, especially when a facility does not have inhalation gases such as isoflurane, sevoflurane, and desflurane present on site or when the depolarizing muscle relaxant succinylcholine is used or present only for use in emergency airway rescue.
If your facility is a QUAD A Class C Medicare Ambulatory Surgery Center (ASC), or a non-Medicare Office-Based Surgery (OBS) facility, and you do not have any inhalation gases or succinylcholine present, then section 6-G does not apply to you. Additionally, if your facility has chosen to have rocuronium present, section 6-G does not apply.
When facilities have succinylcholine present only for emergency airway rescue, only standard 6-G-1 applies.
6-G-1
If the depolarizing muscle relaxant succinylcholine is present only for use in emergency airway rescue, the facility must:
- Document a protocol to manage the possibility of malignant hyperthermia (MH) following its use.
- Train staff upon hire and annually (training not a drill.
If your facility stocks or uses any of the following potential MH triggering agents:
- Inhalation anesthetic gases, isoflurane, sevoflurane, and desflurane.
- Depolarizing muscle relaxant succinylcholine (other than succinylcholine being present for emergency airway rescue), then standards 6-G-2 through 6-G-10 apply.
MH standards do not apply to facility classes A and B.
We hope this information clarifies what is needed for facility compliance with our standards related to MH when there are no gases or succinylcholine present. Should you have any questions, please email them to standards@quada.org.
Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.
