Abstract
To détérmine the incidence of malignant hyperthermia (MH) reactions after trigger-free anaesthesia in a large population of MH-susceptible (MHS) patients, the charts of 2,214 patients who underwent elective muscle biopsy for malignant hyperthermia were reviewed. Either general or regional anaesthesia with non-triggering drugs was used. For general anaesthesia, the trachea was intubated in the absence of muscle relaxants. The halothane/caffeine contracture test was performed on the biopsied muscle. Suspected MH reactions were identified according to their site of occurrence (in the operating room, recovery room or ward). Ninetyseven percent of patients received a general anaesthetic; 3% received a regional anaesthetic or field block. Of the 2214 patients whose muscles were biopsied, 1082 patients were biopsy-positive for MH. Five patients in whom MH reactions were diagnosed in the recovery room were all subsequently proved to be biopsy-positive for MH. Four of the five received intravenous dantrolene as part of their therapy; the fifth received only symptomatic therapy as parenteral dantrolene was not commercially available. All patients recovered complétély from their reactions. We conclude that the incidence of MH reactions in biopsy-positive patients who receive a trigger-free anaesthetic for minor surgery is small (0.46%, (0.15– 1.07%, 95% CI)). These reactions occur in the immediate postoperative period.
Résumé
Dans le but de détérminer l’incidence des réactions d’hyperthermie maligne (HM) après une anesthésie libre d’agent déclenchant dans une population importante de patients susceptibles, les dossiers de 2 214 patients soumis à une biopsie musculaire en chirurgie réglée ont été révisés. Une anesthésie générale ou régionale avait été administrée. Pour la générate, la trachée avait été intubée sans myorelaxants. Le test de contracture à l’halothane/caféine était réalisé sur l’echantillon de muscle prélevé. Les réactions suspectes d’HM étaient identifiées selon l’endroit de lew apparition (salle d’opération, salle de réveil ou étage) Quatrevingt-dix-sept pour cent des biopsies ont été effectuées sous anesthésie générate et 3% sous régionale ou infiltration locale. Des 2214 patients biopsiés, 1082 étaient positifs pour l’HM. Chez les cinq patients dont le diagnostic avait été fait en salle de réveil, tous avaient une biopsie positive. Quatre de ceuxci ont été traités au dantrolène intraveineux; comme le dantrolène n’était pas encore sur le marché pour le cinquième, un traitement purement symptomatique a été administré. La récupération a été totale pour tous les patients. Nous concluons que l’incidence des réactions d’HM chez les porteurs d’une biopsie positive est minime lorsqu’ils subissent une biopsie musculaire avec des anesthésiques libres d’agent déclenchant (0,46%, (0,15– 1,07%, IC 95%)). Ces réactions surviennent à la période postopératoire immédiate.
Article PDF
Similar content being viewed by others
References
Britt BA. Dantrolene — an update.In: Britt BA (Ed.). Malignant Hyperthermia. Boston: Martinus Nijhoff Publishing 1987: 325–67.
Prather Strazis K, Fox AW. Malignant hyperthermia: a review of published cases. Anesth Analg 1993; 77: 297–304.
Britt BA. Malignant hyperthermia: a review.In: Milton AS (Ed.). Handbook of Experimental Pharmacology. Berlin: Springer-Verlag 1982: 547–615.
Kolb MS, Home ML, Martz R. Dantrolene in human malignant hyperthermia. A multicenter study. Anesthesiology 1982; 56: 254–62.
Ording H, Hedengran AM, Skovgaard LT. Evaluation of 119 anaesthetics received after investigation for susceptibility to malignant hyperthermia. Acta Anaesthesiol Scand 1991; 35: 711–6.
Ording H, Nielsen VG. Atracurium and its antagonism by neostigmine (plus glycopyrrolate) in patients susceptible to malignant hyperthermia. Br J Anaesth 1986; 58: 1001–4.
Larach MG, Rosenberg H, Larach DR, Broennle AM. Prediction of malignant hyperthermia susceptibility by clinical signs. Anesthesiology 1987; 66: 547–50.
Ording H, Fonsmark L. Use of vecuronium and doxapram in patients susceptible to malignant hyperthermia. Br J Anaesth 1988; 60: 445–9.
Gielen M, Viering W. 3-in-1 lumbar plexus block for muscle biopsy in malignant hyperthermia patients. Amide local anaesthetics may be used safely. Acta Anaesthesiol Scand 1986; 30: 581–3.
Berkowitz A, Rosenberg H. Femoral block with mepivacaine for muscle biopsy in malignant hyperthermia patients. Anesthesiology 1985; 62: 651–2.
Britt BA. Malignant hyperthermia — a review.In: Schonbaum E, Lomax P (Eds.). Thermoregulation: Pathology, Pharmacology and Therapy. New York: Pergamon Press, Inc. 1991: 179–292.
Larach MG, Localio AR, Allen GC, et al. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology 1994; 80: 771–9.
Zar JH. Biostatistical Analysis, 2nd ed. Englewood Cliffs: Prentice-Hall, Inc., 1984: 378–9.
Hanley JA, Lippman-Hand A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA 1983; 249: 1743–5.
Grinberg R, Edelist G, Gordon A. Postoperative malignant hyperthermia episodes in patients who received “safe” anaesthetics. Can Anaesth Soc J 1983; 30: 273–6.
Larach MG for the North American Malignant Hyperthermia Group. Standardization of the caffeine halothane muscle contracture test. Anesth Analg 1989; 69: 511–5.
Britt BA. Elective and emergency treatment of malignant hyperthermic susceptible patients.In: Nalda F, Gottmann S, Khambatta HJ (Eds.). Malignant Hyperthermia: Current Concepts. International Course, Barcelona, Spain, September 15–17, 1988. Bad Homburg: Normed Verlag, 1989; 108–32.
Gronert GA, Milde JH. Variations in onset of porcine malignant hyperthermia. Anesth Analg 1981; 60: 499–503.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Carr, A.S., Lerman, J., Cunliffe, M. et al. Incidence of malignant hyperthermia reactions in 2,214 patients undergoing muscle biopsy. Can J Anaesth 42, 281–286 (1995). https://doi.org/10.1007/BF03010703
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03010703