Sevoflurane is less sensitive than halothane for in vitro detection of malignant hyperthermia susceptibility

2013 ◽  
Vol 57 (9) ◽  
pp. 1161-1166 ◽  
Author(s):  
S. JOHANNSEN ◽  
W. KLINGLER ◽  
D. SCHNEIDERBANGER ◽  
S. HEIDERICH ◽  
N. ROEWER ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Malignant Hyperthermia Susceptibility

In Vitro Diagnosis of Malignant Hyperthermia Susceptibility with Ryanodine-Induced Contractures in Human Skeletal Muscles

1996 ◽  
Vol 82 (6) ◽  
pp. 1230-1236 ◽  
Author(s):  
Frank Wappler ◽  
Norbert Roewer ◽  
Andreas Kochling ◽  
Jens Scholz ◽  
Markus Steinfath ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Skeletal Muscles ◽  
Malignant Hyperthermia Susceptibility ◽  
Human Skeletal Muscles ◽  
In Vitro Diagnosis

Suspected Malignant Hyperthermia Reactions in New Zealand

2002 ◽  
Vol 30 (4) ◽  
pp. 453-461 ◽  
Author(s):  
A. N. Pollock ◽  
E. E. Langton ◽  
K. Couchman ◽  
K. M. Stowell ◽  
M. Waddington
Keyword(s):  
New Zealand ◽  
Malignant Hyperthermia ◽  
Dna Analysis ◽  
Anaesthetic Agent ◽  
Clinical Signs ◽  
Malignant Hyperthermia Susceptibility ◽  
In Vitro Contracture Test ◽  
Grading Scale ◽  
Clinical Grading

Early clinical signs, triggering agents, time to onset of reaction, mortality and methods of treatment were identified in 123 suspected malignant hyperthermia reactions. In vitro contracture test results were compared with clinical signs and the Malignant Hyperthermia Clinical Grading Scale. Increased end-tidal carbon dioxide is the earliest sign when not preceded by masseter spasm. Earlier diagnosis reduces the incidence of rigidity and severe metabolic acidosis. The combination of suxamethonium and a potent volatile anaesthetic agent triggers an earlier reaction compared with a volatile agent alone. There has been zero mortality since 1981, essentially due to a combination of advanced monitoring capability, increased anaesthetist awareness of malignant hyperthermia, and dantrolene availability. DNA analysis has identified nine New Zealand families with ryanodine receptor gene mutations. A positive DNA test indicates malignant hyperthermia susceptibility with “causative” mutations but discordance requires that negative DNA tests are confirmed with in vitro contracture test. This test also demonstrated the shortcomings of the Malignant Hyperthermia Clinical Grading Scale.

scholarly journals Muscle Biopsy and In Vitro  Contracture Test in Subjects with Idiopathic HyperCKemia

2008 ◽  
Vol 109 (4) ◽  
pp. 625-628 ◽  
Author(s):  
Alessandro Malandrini ◽  
Alfredo Orrico ◽  
Carmen Gaudiano ◽  
Simona Gambelli ◽  
Lucia Galli ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Muscle Biopsy ◽  
Malignant Hyperthermia Susceptibility ◽  
Manual Muscle Testing ◽  
In Vitro Contracture Test ◽  
Muscle Testing ◽  
Malignant Hyperthermia Susceptible ◽  
Fiber Size ◽  
Precise Diagnosis

Background Persistent high creatine kinase (CK) levels may reflect underlying subclinical myopathies. In most cases, pathogenesis is unknown and clinical management is unclear. Though clinically asymptomatic, these subjects are potentially susceptible to malignant hyperthermia. Methods The authors analyzed 37 subjects with persistent elevation of CK without significant weakness or other neurologic symptoms. Neurologic examination was performed according to manual muscle testing. Muscle biopsy and the in vitro contracture test were performed in all subjects. Results Twenty-three subjects (51.1%) were completely asymptomatic. The others had minor symptoms such as occasional cramps (11 subjects, 24.4%), fatigue (5 subjects, 11.1%), a combination of cramps and fatigue (5 subjects, 11.1%), and muscle pain (1 case, 2.2%). Muscle biopsy enabled precise diagnosis in 3 cases and was normal in 3 cases. The more frequent changes were variation in fiber size (31.1%), a combination of nuclear internalization and variation in fiber size (26.6%), nuclear internalization (6.6%), minor mitochondrial changes (4.4%), and neurogenic atrophy (4.4%). Immunocytochemical analysis was normal in all patients. In vitro contracture testing detected one malignant hyperthermia-susceptible and one malignant hyperthermia-equivocal subject. Conclusions The evidence of malignant hyperthermia susceptibility by in vitro contracture test seems to be relatively infrequent among subjects with idiopathic hyperCKemia, but the incidence of true malignant hyperthermia in idiopathic hyperCKemia is unknown. Muscle biopsy should be considered a useful, though not very sensitive, diagnostic tool in idiopathic hyperCKemia, because it enables potentially treatable disorders, such as inflammatory myopathies, to be discovered. No uniform morphologic finding typical of idiopathic hyperCKemia or malignant hyperthermia susceptibility was identified by muscle biopsy.

scholarly journals A Minimal-Invasive Metabolic Test Detects Malignant Hyperthermia Susceptibility in a Patient after Sevoflurane-Induced Metabolic Crisis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Frank Schuster ◽  
Stephan Johannsen ◽  
Norbert Roewer
Keyword(s):  
Malignant Hyperthermia ◽  
Intramuscular Injection ◽  
Diagnostic Procedures ◽  
Minimal Invasive ◽  
Malignant Hyperthermia Susceptibility ◽  
Inhalation Anesthetics ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Metabolic Test

Malignant hyperthermia is a rare but life-threatening complication of general anesthesia in predisposed patients usually triggered by potent inhalation anesthetics and/or the depolarizing muscle relaxant succinylcholine. The authors present a case of delayed sevoflurane-induced malignant hyperthermia in a 21-year-old male patient that was sufficiently treated by discontinuation of trigger agent application and dantrolene infusion. After surviving an MH episode diagnostic procedures are indicated to increase patient safety. In the presented case, the use of a novel minimal-invasive metabolic test with intramuscular injection of halothane and caffeine successfully confirmed MH susceptibility and hence might be an alternative for invasive in vitro contracture testing in selected cases.

scholarly journals Lymphocyte-based Determination of Susceptibility to Malignant Hyperthermia: A Pilot Study in Swine

2010 ◽  
Vol 113 (4) ◽  
pp. 917-924 ◽  
Author(s):  
Saiid Bina ◽  
John Capacchione ◽  
Sheila Muldoon ◽  
Munkhuu Bayarsaikhan ◽  
Rolf Bunger
Keyword(s):  
Malignant Hyperthermia ◽  
High Performance ◽  
Human Lymphocytes ◽  
Malignant Hyperthermia Susceptibility ◽  
Swine Model ◽  
Arterial Blood ◽  
Stimulation Of

Background Malignant hyperthermia susceptibility (MHS) is diagnosed by an invasive in vitro caffeine-halothane contracture test (CHCT) carried out on biopsied skeletal muscle tissue. We are presenting a novel blood test approach for malignant hyperthermia testing in a swine model. Our main aim was to determine whether adenosine production from lymphocytes after 4-chloro-m-cresol (4CmC) stimulation distinguishes homozygous swine carrying the Arg615Cys mutation in the ryanodine receptor type 1 (RyR1) gene (MHS swine) from normal swine. Methods Lymphocytes were isolated from arterial blood (40 ml) obtained from MHS (n = 7) and normal (n = 7) swine. Cells were suspended in Hank's balanced salt solution and treated with 4CmC (0-10 mm) at 37°C in the presence of adenosine deaminase inhibitor. After termination and purification of samples, aliquots (50 μl) were assayed for adenosine content using high performance liquid chromatography. Results Baseline adenosine levels before stimulating lymphocytes with 4CmC were 0.025 ± 0.004 and 0.041 ± 0.006 μm (mean ± SEM) in lymphocytes from normal and MHS swine, respectively (P = 0.125). Maximum responses were achieved at 1 mm 4CmC for both cell-line groups. Adenosine levels after stimulation with 4CmC (1 mm) were 0.185 ± 0.009 and 0.397 ± 0.038 μm in lymphocytes from normal and MHS swine, respectively (P = 0.0035). There was no overlap between adenosine levels in stimulated lymphocytes from MHS and normal swine. Conclusion 4CmC stimulation of porcine lymphocytes induces increased adenosine formation in MHS cells relative to those from normal swine; evaluation of adenosine formation in response to RyR1 agonists in human lymphocytes is needed.

Sign in / Sign up

Export Citation Format

Share Document