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In-vitro contracture testing for susceptibility to malignant hyperthermia: can halothane be replaced?
Eur J Anaesthesiol. 2011 Apr; 28(4):251-5.EJ

Abstract

BACKGROUND

Malignant hyperthermia is a potentially lethal inherited hypermetabolic syndrome that develops in susceptible individuals following administration of depolarising neuromuscular relaxants or volatile anaesthetics. Genetic analysis can only confirm a diagnosis of malignant hyperthermia in about 70%, and in the remainder an in-vitro contracture test, with halothane and caffeine, on muscle obtained from open muscle biopsy is required to establish the diagnosis. As the licence for clinical use of halothane expired in 2005, its continuing availability is in doubt. More modern volatile anaesthetics such as enflurane, isoflurane, desflurane and sevoflurane are less potent triggers of malignant hyperthermia in humans and pigs. The aim of this study was to investigate whether these agents can be considered possible substitutes for halothane in a modified in-vitro contracture test.

METHOD

With institutional review board approval and prior written consent, muscle bundles of 30 patients with a personal or family history of malignant hyperthermia were investigated. Of these, 13 were diagnosed malignant hyperthermia susceptible and 17 nonsusceptible. Surplus muscle was tested with increasing concentrations of enflurane, isoflurane, desflurane and sevoflurane.

RESULTS

There were no differences in weight, length or predrug tension of the muscle bundles. At increasing concentration, all volatile anaesthetics except sevoflurane induced significantly greater contractures in malignant hyperthermia susceptible compared to malignant hyperthermia nonsusceptible muscle. In malignant hyperthermia susceptible muscle bundles, halothane led to significantly higher contractures compared to the other investigated substances.

CONCLUSION

Halothane was the strongest discriminator for malignant hyperthermia in the in-vitro contracture tests. It remains the ideal substance for diagnostic testing and cannot simply be replaced by other agents in this test.

Authors+Show Affiliations

Department of Anaesthesiology, University Würzburg, Würzburg, Germany. tom.metterlein@gmx.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20827211

Citation

Metterlein, Thomas, et al. "In-vitro Contracture Testing for Susceptibility to Malignant Hyperthermia: Can Halothane Be Replaced?" European Journal of Anaesthesiology, vol. 28, no. 4, 2011, pp. 251-5.
Metterlein T, Schuster F, Kranke P, et al. In-vitro contracture testing for susceptibility to malignant hyperthermia: can halothane be replaced? Eur J Anaesthesiol. 2011;28(4):251-5.
Metterlein, T., Schuster, F., Kranke, P., Roewer, N., & Anetseder, M. (2011). In-vitro contracture testing for susceptibility to malignant hyperthermia: can halothane be replaced? European Journal of Anaesthesiology, 28(4), 251-5. https://doi.org/10.1097/EJA.0b013e32833ed06c
Metterlein T, et al. In-vitro Contracture Testing for Susceptibility to Malignant Hyperthermia: Can Halothane Be Replaced. Eur J Anaesthesiol. 2011;28(4):251-5. PubMed PMID: 20827211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-vitro contracture testing for susceptibility to malignant hyperthermia: can halothane be replaced? AU - Metterlein,Thomas, AU - Schuster,Frank, AU - Kranke,Peter, AU - Roewer,Norbert, AU - Anetseder,Martin, PY - 2010/9/10/entrez PY - 2010/9/10/pubmed PY - 2013/7/24/medline SP - 251 EP - 5 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 28 IS - 4 N2 - BACKGROUND: Malignant hyperthermia is a potentially lethal inherited hypermetabolic syndrome that develops in susceptible individuals following administration of depolarising neuromuscular relaxants or volatile anaesthetics. Genetic analysis can only confirm a diagnosis of malignant hyperthermia in about 70%, and in the remainder an in-vitro contracture test, with halothane and caffeine, on muscle obtained from open muscle biopsy is required to establish the diagnosis. As the licence for clinical use of halothane expired in 2005, its continuing availability is in doubt. More modern volatile anaesthetics such as enflurane, isoflurane, desflurane and sevoflurane are less potent triggers of malignant hyperthermia in humans and pigs. The aim of this study was to investigate whether these agents can be considered possible substitutes for halothane in a modified in-vitro contracture test. METHOD: With institutional review board approval and prior written consent, muscle bundles of 30 patients with a personal or family history of malignant hyperthermia were investigated. Of these, 13 were diagnosed malignant hyperthermia susceptible and 17 nonsusceptible. Surplus muscle was tested with increasing concentrations of enflurane, isoflurane, desflurane and sevoflurane. RESULTS: There were no differences in weight, length or predrug tension of the muscle bundles. At increasing concentration, all volatile anaesthetics except sevoflurane induced significantly greater contractures in malignant hyperthermia susceptible compared to malignant hyperthermia nonsusceptible muscle. In malignant hyperthermia susceptible muscle bundles, halothane led to significantly higher contractures compared to the other investigated substances. CONCLUSION: Halothane was the strongest discriminator for malignant hyperthermia in the in-vitro contracture tests. It remains the ideal substance for diagnostic testing and cannot simply be replaced by other agents in this test. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/20827211/In_vitro_contracture_testing_for_susceptibility_to_malignant_hyperthermia:_can_halothane_be_replaced L2 - https://doi.org/10.1097/EJA.0b013e32833ed06c DB - PRIME DP - Unbound Medicine ER -