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Sevoflurane is less sensitive than halothane for in vitro detection of malignant hyperthermia susceptibility.
Acta Anaesthesiol Scand. 2013 Oct; 57(9):1161-6.AA

Abstract

BACKGROUND

Sevoflurane is a known triggering agent of malignant hyperthermia (MH). The present study analyzed different effects of sevoflurane on skeletal muscle of MH susceptible and nonsusceptible individuals in vitro and compared the results to the standardized test protocol with halothane and caffeine. A potential influence of a present ryanodine receptor type 1 (RyR1) mutation was investigated.

METHODS

Muscle bundles of 24 MH-susceptible patients with or without an RyR1 mutation, 35 MH-nonsusceptible and 10 MH-equivocal patients were exposed either to sevoflurane 8 vol% bolus or increasing doses of 2, 4, 6, and 8 vol%. In MH-positive patients, a screening for mutations in the RyR1 gene was performed.

RESULTS

The in vitro parameters initial length, weight, predrug resting tension, and predrug twitch height did not differ between the groups. Sevoflurane caused significant contractures in MH-susceptible but not in MH-nonsusceptible muscle after increasing doses [1.4 (0.3-6.0) vs. 0 (0-0) mN] and after bolus application [6.9 (2.4-21.4) vs. 0 (0-0) mN]. However, only 50% of the susceptible patients developed contractures ≥ 2 mN after increasing concentrations while 83% did so after rapid bolus administration. Presence of an RyR1 mutation was detected in 36% of the examined MH-positive patients but had no influence on developing contractures.

CONCLUSION

Sevoflurane-induced contractures do not reliably detect MH susceptibility on an individual level. Therefore, sevoflurane is no suitable alternative for diagnostic use. Mutation-specific effects regarding contracture sizes after incubation with sevoflurane, halothane, or caffeine were not found.

Authors+Show Affiliations

Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23957432

Citation

Johannsen, S, et al. "Sevoflurane Is Less Sensitive Than Halothane for in Vitro Detection of Malignant Hyperthermia Susceptibility." Acta Anaesthesiologica Scandinavica, vol. 57, no. 9, 2013, pp. 1161-6.
Johannsen S, Klingler W, Schneiderbanger D, et al. Sevoflurane is less sensitive than halothane for in vitro detection of malignant hyperthermia susceptibility. Acta Anaesthesiol Scand. 2013;57(9):1161-6.
Johannsen, S., Klingler, W., Schneiderbanger, D., Heiderich, S., Roewer, N., & Schuster, F. (2013). Sevoflurane is less sensitive than halothane for in vitro detection of malignant hyperthermia susceptibility. Acta Anaesthesiologica Scandinavica, 57(9), 1161-6. https://doi.org/10.1111/aas.12171
Johannsen S, et al. Sevoflurane Is Less Sensitive Than Halothane for in Vitro Detection of Malignant Hyperthermia Susceptibility. Acta Anaesthesiol Scand. 2013;57(9):1161-6. PubMed PMID: 23957432.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sevoflurane is less sensitive than halothane for in vitro detection of malignant hyperthermia susceptibility. AU - Johannsen,S, AU - Klingler,W, AU - Schneiderbanger,D, AU - Heiderich,S, AU - Roewer,N, AU - Schuster,F, Y1 - 2013/08/19/ PY - 2013/07/15/accepted PY - 2013/8/21/entrez PY - 2013/8/21/pubmed PY - 2014/4/12/medline SP - 1161 EP - 6 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 57 IS - 9 N2 - BACKGROUND: Sevoflurane is a known triggering agent of malignant hyperthermia (MH). The present study analyzed different effects of sevoflurane on skeletal muscle of MH susceptible and nonsusceptible individuals in vitro and compared the results to the standardized test protocol with halothane and caffeine. A potential influence of a present ryanodine receptor type 1 (RyR1) mutation was investigated. METHODS: Muscle bundles of 24 MH-susceptible patients with or without an RyR1 mutation, 35 MH-nonsusceptible and 10 MH-equivocal patients were exposed either to sevoflurane 8 vol% bolus or increasing doses of 2, 4, 6, and 8 vol%. In MH-positive patients, a screening for mutations in the RyR1 gene was performed. RESULTS: The in vitro parameters initial length, weight, predrug resting tension, and predrug twitch height did not differ between the groups. Sevoflurane caused significant contractures in MH-susceptible but not in MH-nonsusceptible muscle after increasing doses [1.4 (0.3-6.0) vs. 0 (0-0) mN] and after bolus application [6.9 (2.4-21.4) vs. 0 (0-0) mN]. However, only 50% of the susceptible patients developed contractures ≥ 2 mN after increasing concentrations while 83% did so after rapid bolus administration. Presence of an RyR1 mutation was detected in 36% of the examined MH-positive patients but had no influence on developing contractures. CONCLUSION: Sevoflurane-induced contractures do not reliably detect MH susceptibility on an individual level. Therefore, sevoflurane is no suitable alternative for diagnostic use. Mutation-specific effects regarding contracture sizes after incubation with sevoflurane, halothane, or caffeine were not found. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/23957432/Sevoflurane_is_less_sensitive_than_halothane_for_in_vitro_detection_of_malignant_hyperthermia_susceptibility_ L2 - https://doi.org/10.1111/aas.12171 DB - PRIME DP - Unbound Medicine ER -