1
|
Malignant hyperthermia, environmental heat stress, and intracellular calcium dysregulation in a mouse model expressing the p.G2435R variant of RYR1. Br J Anaesth 2018; 121:953-961. [PMID: 30236258 DOI: 10.1016/j.bja.2018.07.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/22/2018] [Accepted: 07/16/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The human p.G2434R variant of the RYR1 gene is most frequently associated with malignant hyperthermia (MH) in the UK. We report the phenotype of a knock-in mouse that expresses the RYR1 variant p.G2435R, which is isogenetic with the human variant. METHODS We observed the general phenotype; determined the sensitivity of myotubes to caffeine-, KCl, and halothane-induced Ca2+ release; determined the in vivo response to halothane or increased ambient temperature; and determined the in vivo myoplasmic intracellular Ca2+ concentration in skeletal muscle before and during exposure to volatile anaesthetics. RESULTS RYR1 pG2435R/MH normal (MHS-Heterozygous[Het]) or RYR1 pG2435R/pG2435R (MHS-Homozygous[Hom]) mice were fully viable under typical rearing conditions, although some male MHS-Hom mice died spontaneously. The normalised half-maximal effective concentration (95% confidence interval) for intracellular Ca2+ release in myotubes in response to KCl [MH normal, MHN, 21.4 (19.8-23.1) mM; MHS-Het 16.2 (15.2-17.2) mM; MHS-Hom 11.2 (10.2-12.2) mM] and caffeine (MHN, 5.7 (5-6.3) mM; MHS-Het 4.5 (3.9-5.0) mM; MHS-Hom 1.77 (1.5-2.1) mM] exhibited a gene dose-dependent decrease, and there was a gene dose-dependent increase in halothane sensitivity. Intact animals show a gene dose-dependent susceptibility to MH with volatile anaesthetics or to heat stroke. RYR1 p.G2435R mice had elevated skeletal muscle intracellular resting [Ca2+]i, (values are expressed as mean (SD)) (MHN 123 (3) nM; MHS-Het 156 (16) nM; MHS-Hom 265 (32) nM; P<0.001) and [Na+]i (MHN 8 (0.1) mM; MHS-Het 10 (1) mM; MHS-Hom 14 (0.7) mM; P<0.001) that was further increased by exposure to volatile anaesthetics. CONCLUSIONS RYR1 pG2435R mice demonstrated gene dose-dependent in vitro and in vivo responses to pharmacological and environmental stressors that parallel those seen in patients with the human RYR1 variant p.G2434R.
Collapse
|
2
|
Frei D, Stowell KM, Langton EE, McRedmond L, Pollock NA, Bulger TF. Administration of Anaesthetic Triggering Agents to Patients Tested Malignant Hyperthermia Normal and Their Relatives in New Zealand: An Update. Anaesth Intensive Care 2017; 45:611-618. [DOI: 10.1177/0310057x1704500512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Testing for malignant hyperthermia in New Zealand involves two tests—in vitro contracture testing of excised lateral quadriceps muscle and DNA analysis. In vitro contracture testing is regarded as the gold standard in malignant hyperthermia diagnosis but several publications have questioned the reliability of a normal result. Analysis of 479 anaesthetic records in 280 patients or their descendants throughout New Zealand who had tested negative for malignant hyperthermia, demonstrated there was no evidence of malignant hyperthermia episodes in this group who had been administered anaesthetic triggering agents. A wide range of anaesthetics were used over the study period. Analysis of each anaesthetic record was undertaken using the malignant hyperthermia grading scale which determines the likelihood that an anaesthetic event represents a malignant hyperthermia episode. Confirmation of the negative results was further supported by normal DNA analysis of patients in 48% of anaesthetics. There are advantages to using inhalational agents in certain situations and although demonstrating a zero risk of a malignant hyperthermia episode is not statistically possible, evidence in this large series suggests that the risk of an episode in these patients is extremely low and may be negligible. We suggest that anaesthetic triggering agents can be used safely in patients with normal in vitro contracture tests, and in their descendants.
Collapse
Affiliation(s)
- D. Frei
- Department of Anaesthesia and Pain Management, Wellington Regional Hospital, Wellington, New Zealand
| | - K. M. Stowell
- Institute of Fundamental Sciences, Massey University, Palmerston North, Manawatu, New Zealand
| | - E. E. Langton
- Specialist Anaesthetist, Department of Anaesthesia and Pain Management, Wellington Regional Hospital, Wellington, New Zealand
| | - L. McRedmond
- University of Auckland Medical School, University of Auckland, Auckland, New Zealand
| | - N. A. Pollock
- Department of Anaesthesia and Intensive Care, Palmerston North Hospital, Palmerston North, Manawatu, New Zealand
| | - T. F. Bulger
- Department of Anaesthesia and Intensive Care, Palmerston North Hospital, Palmerston North, Manawatu, New Zealand
| |
Collapse
|
3
|
Pollock N, Langton EE, Stowell KM, Bulger TF. Safety of exposure of malignant hyperthermia non-susceptible patients and their relatives to anaesthetic triggering agents. Anaesth Intensive Care 2011; 39:887-94. [PMID: 21970134 DOI: 10.1177/0310057x1103900514] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the reliability of malignant hyperthermia normal in vitro contracture test results has been questioned, this study set out to determine the reliability of malignant hyperthermia normal results in New Zealand. Three hundred and twenty-nine anaesthetics were administered to malignant hyperthermia normal patients, identified through the Palmerston North Hospital malignant hyperthermia database. Anaesthetic records were retrieved and scrutinised for a malignant hyperthermia reaction using the Malignant Hyperthermia Clinical Grading Scale. Patients were exposed to one or more of eight triggering agents and multiple anaesthetic agents were administered in 41% of cases. Six variables were analysed, and although a minority of variables were abnormal in a small number of patients, none of the findings supported a malignant hyperthermia reaction. While the analysis was limited by the adequacy of the anaesthesia records, it was supported by negative DNA analysis in 55% of patients. This study supports several previous studies in demonstrating that patients in New Zealand tested non-susceptible to malignant hyperthermia can safely be given triggering agents.
Collapse
Affiliation(s)
- N Pollock
- Department of Anaesthesia, Palmerston North Hospital, Palmerston North, New Zealand.
| | | | | | | |
Collapse
|
4
|
Carpenter D, Robinson RL, Quinnell RJ, Ringrose C, Hogg M, Casson F, Booms P, Iles DE, Halsall PJ, Steele DS, Shaw MA, Hopkins PM. Genetic variation in RYR1 and malignant hyperthermia phenotypes. Br J Anaesth 2009; 103:538-48. [PMID: 19648156 DOI: 10.1093/bja/aep204] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Malignant hyperthermia (MH) is associated, in the majority of cases, with mutations in RYR1, the gene encoding the skeletal muscle ryanodine receptor. Our primary aim was to assess whether different RYR1 variants are associated with quantitative differences in MH phenotype. METHODS The degree of in vitro pharmacological muscle contracture response and the baseline serum creatine kinase (CK) concentration were used to generate a series of quantitative phenotypes for MH. We then undertook the most extensive RYR1 genotype-phenotype correlation in MH to date using 504 individuals from 204 MH families and 23 RYR1 variants. We also determined the association between a clinical phenotype and both the laboratory phenotype and RYR1 genotype. RESULTS We report a novel correlation between the degree of in vitro pharmacological muscle contracture responses and the onset time of the clinical MH response in index cases (P<0.05). There was also a significant correlation between baseline CK concentration and clinical onset time (P=0.039). The specific RYR1 variant was a significant determinant of the severity of each laboratory phenotype (P<0.0001). CONCLUSIONS The MH phenotype differs significantly with different RYR1 variants. Variants leading to more severe MH phenotype are distributed throughout the gene and tend to lie at relatively conserved sites in the protein. Differences in phenotype severity between RYR1 variants may explain the variability in clinical penetrance of MH during anaesthesia and why some variants have been associated with exercise-induced rhabdomyolysis and heat stroke. They may also inform a mutation screening strategy in cases of idiopathic hyperCKaemia.
Collapse
Affiliation(s)
- D Carpenter
- MH Investigation Unit, Academic Unit Anaesthesia, St James's University Hospital, Leeds LS9 7TF, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Halsall PJ, Robinson RL. Malignant hyperthermia and associated conditions. HANDBOOK OF CLINICAL NEUROLOGY 2007; 86:107-124. [PMID: 18808997 DOI: 10.1016/s0072-9752(07)86005-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
6
|
|
7
|
Strecker G, Adnet P, Forget AP, Krivosic-Horber R. [Malignant hyperthermia and appendicular sepsis. Can they be differentiated during surgical procedure?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 16:234-8. [PMID: 9732771 DOI: 10.1016/s0750-7658(97)86407-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the possibility to differentiate clinically intraoperative malignant hyperthermia (MH) and sepsis. STUDY DESIGN Comparative retrospective study of clinical cases. PATIENTS Sixteen patients operated on for acute appendicitis and developing clinical signs of MH confirmed or not by in vitro caffeine halothane contracture tests (IVCT). METHOD To isolate the patients' characteristics with regard to the diagnosis of sepsis and MH crisis. To compare both groups of clinical features with results of IVCT. RESULTS The diagnosis of MH sensitivity has been excluded in ten hyperthermic patients and confirmed in four others with IVCT. No correlation was existing between the importance of perioperative sepsis, MH features and IVTC results. CONCLUSIONS This study confirmed the difficulty to differentiate clinically MH and sepsis during surgery. Considering the severe outcome of MH crisis, it is recommended to start the specific therapy even in case of appendicular sepsis.
Collapse
Affiliation(s)
- G Strecker
- Département d'anesthésie-réanimation chirurgicale I, hôpital R-Salengro, Lille, France
| | | | | | | |
Collapse
|
8
|
Robinson R, Curran JL, Hall WJ, Halsall PJ, Hopkins PM, Markham AF, Stewart AD, West SP, Ellis FR. Genetic heterogeneity and HOMOG analysis in British malignant hyperthermia families. J Med Genet 1998; 35:196-201. [PMID: 9541102 PMCID: PMC1051241 DOI: 10.1136/jmg.35.3.196] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Malignant hyperthermia (MH) is an autosomal dominant genetic condition that presents in susceptible people undergoing general anaesthesia. The clinical disorder is a major cause of anaesthetic morbidity and mortality. The UK Malignant Hyperthermia Group has performed genetic linkage analysis on 20 large, well defined malignant hyperthermia families, using hypervariable markers on chromosome 19q13.1, including the candidate MH gene RYR1, the gene coding for the skeletal muscle ryanodine receptor protein. The results were analysed using LINKAGE to perform two point and multipoint lod scores, then HOMOG to calculate levels of heterogeneity. The results clearly showed genetic heterogeneity between MH families; nine of the families gave results entirely consistent with linkage to the region around RYR1 while the same region was clearly excluded in three families. In the remaining eight MHS families there were single recombinant events between RYR1 and MH susceptibility. HOMOG analysis was of little added benefit in determining the likelihood of linkage to RYR1 in these families. This confirmation of the presence of heterogeneity in the UK MH population, along with the possibility of the presence of two MH genes in some pedigrees, indicates that it would be premature and potentially dangerous to offer diagnosis of MH by DNA based methods at this time.
Collapse
Affiliation(s)
- R Robinson
- Department of Genetics, The University, Leeds, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
There are two types of hypertrophy of the muscles of mastication in man: reactive hypertrophy, the more common form; and nonreactive enlargements-myositic, genetic, myopathic, and idiopathic. Reactive hypertrophy develops when the masticatory muscle workload is increased by local bone and dental disorders; such triggers are not powerful but act over long periods, thus demanding increased endurance. Exercise for endurance has a greater effect on the muscles of mastication than it has on the large muscles of the limbs; these react solely by stimulating the oxidative metabolism of type 1 fibers, whereas masticatory muscle reacts structurally by hypertrophy and progressive type 1 fiber predominance. Eventually enzyme instability of type 1 fibers and end stage atrophy of type 2 fibers may appear. Unexpectedly, lesions have also been found in control masticatory muscle, in particular type 2 fiber specific atrophy like that seen in long-standing acquired autoimmune myasthenia gravis. It is suggested that the adverse lesions in hypertrophied and control masticatory muscle are the consequence of post-activation fatigue.
Collapse
Affiliation(s)
- D G Harriman
- Department of Pathology (Neuropathology), University of Leeds, England
| |
Collapse
|
10
|
Laurence AS, Vanner GK, Collins W, Hopkins PM. Serum and urinary myoglobin following an aborted malignant hyperthermia reaction. Anaesthesia 1996; 51:958-61. [PMID: 8984872 DOI: 10.1111/j.1365-2044.1996.tb14965.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 13-year-old boy presenting for correction of bat ears was anaesthetised with thiopentone and suxamethonium, the administration of which was followed by jaw spasm, poor peripheral perfusion (without cyanosis) and marked tachycardia. The procedure was abandoned, dantrolene and Ringer lactate IL were given intravenously and the patient regained consciousness 1 h later. Levels of serum myoglobin, urinary myoglobin and creatine kinase were followed until they returned to normal. Despite a peak serum myoglobin of 58.000 micrograms.l-1 and peak urinary level of 446,000 micrograms.l-1, no renal impairment occurred. Subsequent testing for susceptibility to malignant hyperthermia proved positive for the patient and four other members of the family.
Collapse
Affiliation(s)
- A S Laurence
- Department of Anaesthetics, Royal Preston Hospital
| | | | | | | |
Collapse
|
11
|
Wallace AJ, Wooldridge W, Kingston HM, Harrison MJ, Ellis FR, Ford PM. Malignant hyperthermia--a large kindred linked to the RYR1 gene. Anaesthesia 1996; 51:16-23. [PMID: 8669559 DOI: 10.1111/j.1365-2044.1996.tb07647.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Malignant hyperthermia susceptibility is genetically heterogeneous. The ryanodine receptor gene on the long arm of chromosome 19 represents an important candidate gene but not all families with malignant hyperthermia demonstrate ryanodine receptor mutations or linkage to this region of 19q. Linkage to chromosome 17 in the region of the adult muscle sodium channel alpha subunit gene has been suggested in some families; others are not linked to either of these loci. For most families the in vitro muscle contracture test remains the only reliable method of predicting susceptibility to malignant hyperthermia. We have performed linkage analysis in a large family group with malignant hyperthermia in which the in vitro muscle contracture test had been carried out using the procedure standardised by the European Malignant Hyperthermia Group. None of the published ryanodine receptor gene mutations associated with malignant hyperthermia susceptibility were detected in affected individuals but linkage to intragenic ryanodine receptor markers strongly suggest that this gene is involved in malignant hyperthermia susceptibility in this family. This enabled accurate predictive testing by DNA analysis in 11 untested subjects at 50% risk.
Collapse
Affiliation(s)
- A J Wallace
- Regional Molecular Genetics Laboratory, St Mary's Hospital, Manchester
| | | | | | | | | | | |
Collapse
|
12
|
Morphologie du muscle agressé. NUTR CLIN METAB 1995. [DOI: 10.1016/s0985-0562(05)80288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
13
|
Steinfath M, Singh S, Scholz J, Becker K, Lenzen C, Wappler F, Köchling A, Roewer N, Schulte am Esch J. C1840-T mutation in the human skeletal muscle ryanodine receptor gene: frequency in northern German families susceptible to malignant hyperthermia and the relationship to in vitro contracture response. J Mol Med (Berl) 1995; 73:35-40. [PMID: 7633940 DOI: 10.1007/bf00203617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In swine, a point mutation in the ryanodine receptor gene can account for all cases of malignant hyperthermia (MH). The frequency of a corresponding mutation in humans (C1840-T) and its relationship to the in vitro contracture profile is unknown. We screened 192 patients from 28 unrelated northern German families for the C1840-T mutation in the human ryanodine receptor gene and tested for MH susceptibility using the in vitro contracture test (IVCT) according to the European MH Protocol. In our patients 106 revealed MH susceptible (MHS), 56 MH nonsusceptible and 30 MH equivocal status following IVCT. In each family one or two individuals had developed clinical signs of MH or a MH crisis. All of these patients were classified MHS. The C1840-T mutation was found in 2 of 28 families (7.1%). All eight individuals of the two families characterized by this mutation revealed MHS status following IVCT. The thresholds for halothane- and caffeine-induced contractures as well as the contracture profiles following cumulative (0.4-10.0 mumol/l every 3 min) and bolus (10 mumol/l) administration of ryanodine were found to be similar in MHS patients with and without the C1840-T mutation. In conclusion, the C1840-T mutation in the human ryanodine receptor gene is a rare abnormality in MHS families. Similar contracture profiles in the presence and absence of this mutation might imply no major functional role with respect to the contracture response. At present, molecular genetic analysis cannot replace IVCT to discover MH susceptibility in humans.
Collapse
Affiliation(s)
- M Steinfath
- Abteilung für Anästhesiologie, Universität Hamburg, Universitäts-Krankenhaus Eppendorf
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Fletcher JE. CURRENT LABORATORY METHODS FOR THE DIAGNOSIS OF MALIGNANT HYPERTHERMIA SUSCEPTIBILITY. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/s0889-8537(21)00692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
15
|
Abstract
The regulation of intracellular free calcium ions (Ca2+) in skeletal muscle at rest and during contraction depends on mechanisms such as Na(+)-Ca2+ exchangers, Ca(2+)-ATPases, and the voltage-sensitive ryanodine receptor. The susceptibility of these regulatory mechanisms to free-radical-mediated damage may be increased because of their location within the lipid membranes of sarcolemma, sarcoplasmic reticulum, and mitochondrion with resultant uncontrolled increases in myoplasmic Ca2+ concentration and cell death. The potentially fatal pharmacogenetic disorder, malignant hyperthermia (MH), is characterised by muscle rigidity, arrhythmias, lactic acidosis, and a rapid rise in body temperature. The sequence of events responsible for the MH syndrome remains uncertain, but it has been variously ascribed to faults in many of the Ca2+ regulatory mechanisms. In swine the condition is associated with a specific mutation in the ryanodine receptor, whereas in humans the syndrome is genetically heterogenous. Free-radical-mediated peroxidation of membrane lipids and proteins also results in the rapid efflux of Ca2+ from organelles, and the detection of products of free radical reactions in tissue from MH-susceptible individuals using electron spin resonance spectroscopy provides evidence for the involvement of free radicals in the MH syndrome.
Collapse
Affiliation(s)
- G G Duthie
- Rowett Research Institute, Bucksburn, Aberdeen, Scotland, UK
| | | |
Collapse
|
16
|
Abstract
Malignant hyperthermia susceptibility remains the commonest cause of death owing to general anaesthesia. This is despite the availability of presymptomatic testing, admittedly by a highly invasive method, and a recognised treatment for implementation immediately a patient shows signs of developing a crisis. Recently the finding of linkage to markers from chromosome 19q13.1-13.2 and the identification of mutations in a candidate gene held out hope of genetic diagnosis being available. However, it is likely that only about 50% of families have a mutation of the skeletal muscle calcium release channel gene. With this degree of genetic heterogeneity, presymptomatic testing based on DNA markers can only be offered at present to a limited number of families where linkage to markers from 19q13.1-13.2 has been clearly shown.
Collapse
Affiliation(s)
- S P Ball
- Department of Biological Sciences, University of Exeter, Washington-Singer Laboratories
| | | |
Collapse
|
17
|
Joffe M, Savage N, Silove M. The biochemistry of malignant hyperthermia: recent concepts. THE INTERNATIONAL JOURNAL OF BIOCHEMISTRY 1992; 24:387-98. [PMID: 1312953 DOI: 10.1016/0020-711x(92)90029-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M Joffe
- Department of Medical Biochemistry, Medical School University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | | | | |
Collapse
|
18
|
Heytens L, Heffron JJ, Camu F. The caffeine contracture test for malignant hyperthermia: caffeine citrate, caffeine benzoate or caffeine free base? Acta Anaesthesiol Scand 1991; 35:541-4. [PMID: 1897351 DOI: 10.1111/j.1399-6576.1991.tb03344.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of the present study was to investigate whether the three different caffeine preparations--caffeine citrate, caffeine benzoate and the free base--used for in vitro diagnosis of malignant hyperthermia susceptibility--produced the same amount of contracture in rat diaphragm. At equimolar caffeine concentrations, the pure base generated more tension in the rat diaphragm muscle than caffeine benzoate or caffeine citrate. The citrate lowers the pH and the free Ca2+ concentration of the test bath and thus suppresses the caffeine contracture. The benzoate is believed to inhibit the caffeine contracture by its carbonyl group in a way similar to the effect of benzocaine.
Collapse
Affiliation(s)
- L Heytens
- Department of Intensive Care, University Hospital Antwerp, Belgium
| | | | | |
Collapse
|
19
|
Ellis FR, Halsall PJ, Christian AS. Clinical presentation of suspected malignant hyperthermia during anaesthesia in 402 probands. Anaesthesia 1990; 45:838-41. [PMID: 2240497 DOI: 10.1111/j.1365-2044.1990.tb14566.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As anaesthetists have become more aware of malignant hyperthermia the mortality rate has fallen, but concommitantly the number of dubious and aborted cases has increased. All probands who developed a suspected malignant hyperthermia reaction during anaesthesia and subsequently underwent muscle biopsy were classified according to the clinical presentation. A probability for malignant hyperthermia can be calculated, using the classification, for each type of clinical presentation; this varied from 0.96 to 0.07. Certain clinical features were found to be of more value as predictors than others; these included a high creative kinase and myoglobinuria. The accuracy of prediction depends on a clear contemporaneous description of the clinical events.
Collapse
Affiliation(s)
- F R Ellis
- University Department of Anaesthesia, St. James's University Hospital, Leeds
| | | | | |
Collapse
|
20
|
Krivosic-Horber R, Adnet P. [Screening tests for malignant hyperthermia susceptibility]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1989; 8:444-56. [PMID: 2560612 DOI: 10.1016/s0750-7658(89)80011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The ideal screening test for malignant hyperthermia susceptibility (MHS) has yet to be discovered. It should be simple noninvasive, yet totally specific and sensitive. Until such an ideal test becomes available, allowing simple routine preoperative screening, tests should only be used in certain specific situations. These include: patients in whom a clinical crisis was suspected; the members of the family of a subject labeled MHS because of a fatal, or otherwise, crisis, or in whom tests were positive; patients with other pathological conditions which could be linked to malignant hyperthermia (MH) (some myopathies, effort or stress MH, neuroleptic malignant syndrome). The various tests proposed in the literature aim at revealing MHN subjects, using or not a triggering agent, halothane most often. However, detecting these abnormalities sometimes gives greater insight into the physiopathology of MH than in the detection of an individual patient's susceptibility. The tests have been classified as in vivo, electrophysiological, blood, and in vitro muscle biochemical, morphological, and pharmacological tests. The discovery of new tests gives renewed hope: CPK levels, platelet tests, calcium sarcoplasmic reticular reuptake, lymphocyte Quin 2 test, nuclear magnetic resonance spectroscopy. However, experts worldwide agree that the only reference test to this day remains the in vitro halothane caffeine contracture tests. These tests have shown their reliability; they must be performed on muscle strips obtained from surgically removed muscle biopsies, by laboratories used to this technique and who have at their disposal a sufficiently large group of MHS subjects with a clear-cut clinical crisis, as well as controls. The patients must therefore travel to these laboratories. The design of common protocols for European laboratories on one hand, and the North American laboratories on the other, is a good guarantee of the reliability of these tests.
Collapse
Affiliation(s)
- R Krivosic-Horber
- Department d'Anesthésie Réanimation Chirurgicale I, Hôpital B, CHR, Lille
| | | |
Collapse
|
21
|
Marks LF, Edwards JC, Linter SP. Propofol during cardiopulmonary bypass in a patient susceptible to malignant hyperpyrexia. Anaesth Intensive Care 1988; 16:482-5. [PMID: 3266064 DOI: 10.1177/0310057x8801600416] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- L F Marks
- Shackleton Department of Anaesthetics, Southampton General Hospital, England, United Kingdom
| | | | | |
Collapse
|
22
|
Kemp DR, Choong LS. Malignant hyperthermia and the conscious patient. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1988; 58:423-7. [PMID: 3178598 DOI: 10.1111/j.1445-2197.1988.tb01092.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 53 year old obese male presented with the signs and symptoms of acute appendicitis and a family history suggesting the possibility of a malignant hyperthermia trait. In spite of spinal anaesthesia the patient developed malignant hyperthermia during the appendicectomy and the attack was successfully aborted with the early use of dantrolene sodium (Dantrium, Norwich Eaton).
Collapse
Affiliation(s)
- D R Kemp
- Dandenong and District Hospital, Victoria, Australia
| | | |
Collapse
|
23
|
Jacquot C, Stieglitz P, Kozak-Reiss G, Krivosic-Horber R, Laxenaire MC, Lienhart A, Nivoche Y. [Registration of peranesthetic cases of malignant hyperthermia in France. An update]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1988; 7:524-34. [PMID: 3223647 DOI: 10.1016/s0750-7658(88)80095-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Sixty-two suspected crises of anaesthetic malignant hyperthermia (MH) were collected between 1969 and 1988 by a retrospective inquiry which lasted four years. 33 patients (53%) died whilst 29 survived. 20 cases were confirmed to be MH, either directly or indirectly by way of muscle biopsy and halothane and caffeine contracture tests carried out according to the European MH group protocol by two laboratories. This group included 11 of the deaths, one family member of whom, at least, is sensitive (MHS), 7 MHS survivors and 2 survivors too young to undergo muscle biopsy but belonging to MHS families. 21 cases were highly suspect of MH: 15 of the deaths which occurred in a typical way, and 6 patients of three different families who have suffered from anaesthetic deaths which, clinically, suggested MH. Another 15 were possible MH cases, all survivors, including one case of Steinert's disease and a brother of a case of central core disease. 2 cases were still being debated, because they had equivocal results for the caffeine test (MHEc); the last 4 had negative muscle biopsies and were excluded. 33 close relatives of the MH patients were diagnosed as MHS. 44 others were found to be free from the genetic predisposition. It was strongly recommended to yet 11 others that they carry the MHS card because they were MHEc. The clinical, surgical and anesthetic pictures were always as described in the literature. The anaesthetic protocols included inhalational agents in 90% of cases; these were combined with suxamethonium in 55% of cases. Dantrolene was only used in 32% of cases, and then at inadequate doses and very often too late; this probably explains the large number of treatment failures. The number of severe forms of MH was also very high in this series (70%). The need to increase the means of prevention and screening for MH in France is stressed.
Collapse
Affiliation(s)
- C Jacquot
- CHRU de Grenoble, Département d'Anesthésie-Réanimation
| | | | | | | | | | | | | |
Collapse
|