The clinician’s judgment whether to consider and assign scores to a particular clinical indicator is very important. For example, tachycardia maybe due to hypovolemia, light anesthesia, or any drugs that can increase heart rate and therefore should not count. Assignment of scores to a particular clinical indicator should be considered within the context of the patient’s underlying medical condition, anesthetic, and surgical procedure. Also, failure to monitor electrocardiogram, end-tidal carbon dioxide, and temperature or failure to obtain key laboratory data, such as blood gases and creatine kinase can result in underestimation of MH likelihood. Additionally, lack of knowledge with regard to the patient’s family’s medical history and early termination of MH triggering agents before a significant adverse anesthetic event develops may produce underestimation of MH likelihood (16).