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Yang L, Tautz T, Zhang S, Fomina A, Liu H. The current status of malignant hyperthermia. J Biomed Res 2020; 34:75-85. [PMID: 32305961 DOI: 10.7555/jbr.33.20180089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Malignant hyperthermia (MH) is a rare and life-threatening pharmacogenetic disorder triggered by volatile anesthetics, the depolarizing muscle relaxant succinylcholine, and rarely by strenuous exercise or environmental heat. The exact prevalence of MH is unknown, and it varies from 1:16 000 in Denmark to 1:100 000 in New York State. The underlying mechanism of MH is excessive calcium release from the sarcoplasmic reticulum (SR), leading to uncontrolled skeletal muscle hyper-metabolism. Genetic mutations in ryanodine receptor type 1 ( RYR1) and CACNA1S have been identified in approximately 50% to 86% and 1% of MH-susceptible (MHS) individuals, respectively. Classic clinical symptoms of MH include hypercarbia, sinus tachycardia, masseter spasm, hyperthermia, acidosis, muscle rigidity, hyperkalemia, myoglobinuria, and etc. There are two types of testing for MH: a genetic test and a contracture test. Contracture testing is still being considered as the gold standard for MH diagnosis. Dantrolene is the only available drug approved for the treatment of MH through suppressing the calcium release from SR. Since clinical symptoms of MH are highly variable, it can be difficult to establish a diagnosis of MH. Nevertheless, prompt diagnosis and treatments are crucial to avoid a fatal outcome. Therefore, it is very important for anesthesiologists to raise awareness and understand the characteristics of MH. This review summarizes epidemiology, clinical symptoms, diagnosis and treatments of MH and any new developments.
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Affiliation(s)
- Lukun Yang
- Department of Anesthesiology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China;Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA 95817, USA
| | - Timothy Tautz
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA 95817, USA
| | - Shulin Zhang
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Alla Fomina
- Department of Physiology and Membrane Biology, University of California Davis Health, Sacramento, CA 95817, USA
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA 95817, USA
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Kaur H, Katyal N, Yelam A, Kumar K, Srivastava H, Govindarajan R. Malignant Hyperthermia. MISSOURI MEDICINE 2019; 116:154-159. [PMID: 31040503 PMCID: PMC6461318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Malignant Hyperthermia (MH) is a life-threatening pharmacogenetic disorder which results from exposure to volatile anesthetic agents and depolarizing muscle relaxants. It manifests as a hypermetabolic response resulting in tachycardia, tachypnea, hyperthermia, hypercapnia, acidosis, muscle rigidity and rhabdomyolysis. An increase in the end-tidal carbon dioxide is one of the earliest diagnostic signs. Dantrolene sodium is effective in the management of MH, and should be available whenever general anesthesia is administered. This review also aims to highlight the genetics and pathology of MH, along with its association with various inherited myopathy syndromes like central core disease, multi-mini core disease, Native-American myopathy, and King-Denborough syndrome.
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Affiliation(s)
- Harleen Kaur
- Harleen Kaur, MBBS, Nakul Katyal, MD, Anudeep Yelam, MBBS, Keerthana Kumar, MBBS, and Raghav Govindarajan, MD, MSMA member since 2013, are in the Department of Neurology, University of Missouri School of Medicine
| | - Nakul Katyal
- Harleen Kaur, MBBS, Nakul Katyal, MD, Anudeep Yelam, MBBS, Keerthana Kumar, MBBS, and Raghav Govindarajan, MD, MSMA member since 2013, are in the Department of Neurology, University of Missouri School of Medicine
| | - Anudeep Yelam
- Harleen Kaur, MBBS, Nakul Katyal, MD, Anudeep Yelam, MBBS, Keerthana Kumar, MBBS, and Raghav Govindarajan, MD, MSMA member since 2013, are in the Department of Neurology, University of Missouri School of Medicine
| | - Keerthana Kumar
- Harleen Kaur, MBBS, Nakul Katyal, MD, Anudeep Yelam, MBBS, Keerthana Kumar, MBBS, and Raghav Govindarajan, MD, MSMA member since 2013, are in the Department of Neurology, University of Missouri School of Medicine
| | - Hirsch Srivastava
- Harleen Kaur, MBBS, Nakul Katyal, MD, Anudeep Yelam, MBBS, Keerthana Kumar, MBBS, and Raghav Govindarajan, MD, MSMA member since 2013, are in the Department of Neurology, University of Missouri School of Medicine
| | - Raghav Govindarajan
- Harleen Kaur, MBBS, Nakul Katyal, MD, Anudeep Yelam, MBBS, Keerthana Kumar, MBBS, and Raghav Govindarajan, MD, MSMA member since 2013, are in the Department of Neurology, University of Missouri School of Medicine
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Metterlein T, Schuster F, Kranke P, Roewer N, Anetseder M. Minimally invasive metabolic testing for malignant hyperthermia susceptibility: a systematic review of the methodology and results. ACTA ACUST UNITED AC 2013; 4:149-58. [PMID: 23484448 DOI: 10.1517/17530051003599344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Malignant hyperthermia (MH) is a potentially lethal hypermetabolic syndrome that develops in susceptible individuals exposed to volatile anesthetics or depolarizing neuromuscular blocking agents. Because genetic screening is successful only in 30 - 50% of all suspected cases, contracture testing following an open muscle biopsy is performed to diagnose MH susceptibility. Two different protocols exist, the in vitro contracture test (IVCT) for Europe and the caffine halothane contracture test for the US. As replacement for the IVCT, an in vivo metabolic test might allow an equal discrimination of MH susceptible individuals. In this systematic review, all available metabolic testing methods are analyzed. WHAT THE READER WILL GAIN The reader will gain insight in methods and results of alternative approaches to diagnose MH. AREAS COVERED IN THIS REVIEW Relevant studies involving in vivo metabolic testing were systematically searched (Medline) and reviewed. Their ability to discriminate MH susceptible individuals was analyzed and compared. Any systemic or local side effects were documented and evaluated in order to allow more robust conclusions based on larger sample sizes than the single trials. TAKE HOME MESSAGE All discussed study protocols allowed an adequate discrimination of MH susceptible individuals. The latest study protocol reaches a specificity of 79% with a sensitivity of 100%. No severe systemic or local adverse effects could be seen in the pooled analysis. Minimally invasive metabolic testing is a promising novel approach to diagnose MH. Further multi-center studies have to be conducted to optimize the results in order to replace the IVCT.
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Affiliation(s)
- Thomas Metterlein
- University of Regensburg, Department of Anaesthesiology, Regensburg, Germany +49 941 944 9055 ; +49 (0) 941 944 9054 ;
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Johannsen S, Berberich C, Metterlein T, Roth C, Reiners K, Roewer N, Schuster F. Screening test for malignant hyperthermia in patients with persistent hyperCKemia: a pilot study. Muscle Nerve 2013; 47:677-81. [PMID: 23400941 DOI: 10.1002/mus.23633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2012] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Persistently elevated serum creatine kinase (CK) is frequently associated with predisposition to malignant hyperthermia (MH). We investigated whether a minimally invasive metabolic test is suitable to diagnose MH susceptibility among patients with hyperCKemia. METHODS Thirty-nine participants were included: 10 were MH susceptible (MHS); 21 MH were non-susceptible (MHN); and 8 had MHN with persistent hyperCKemia >500 U/L. Microdialysis probes were inserted into the vastus lateralis muscle, and halothane or caffeine was injected via an attached microtubing catheter. Lactate concentrations in dialysis samples were measured spectrophotometrically. RESULTS Baseline lactate did not differ between the groups. After local application of halothane or caffeine, a significant lactate increase was detected only in the MHS group. CONCLUSIONS Test results were not influenced by hyperCKemia. To avoid risks and complications of a surgical muscle biopsy this microdialysis test might be a useful screening tool for MH susceptibility among patients with persistent CK elevation.
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Affiliation(s)
- Stephan Johannsen
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Oberduerrbacher Strasse 6, D-97080 Wuerzburg, Germany
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Lee JW, Yi JS, Lee JR, Kim DC. Anesthetic experience for patients with malignant hyperthermia susceptibility determined by molecular genetic test: A report of 2 cases. Korean J Anesthesiol 2009; 57:387-391. [PMID: 30625893 DOI: 10.4097/kjae.2009.57.3.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder manifested as a life threatening hypermetabolic crisis in susceptible individuals following exposure to inhalation anesthetics and to depolarizing muscle relaxants. The preoperative diagnosis of MH susceptibility is difficult. The gold standard for determination of MH susceptibility is the in vitro contracture test. However, it is invasive, requiring skeletal muscle biopsy and is not widely available. Recent advances in genetic testing for mutations that result in MH during anesthesia have helped some genetic test have limitations in clinical application due to the diversity of mutations. In Korea, we found the RYR1 genetic mutation by molecular genetic testing for MH susceptibility in a family for which MH had occurred. Based on the results of genetic testing, we could known MH susceptibility of 2 patients. We believe that the genetic testing for MH can be developed and used with some limitations in clinical settings in Korea.
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Affiliation(s)
- Jeong Woo Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea.
| | - Ji Sun Yi
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea.
| | - Jun Rye Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea.
| | - Dong Chan Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea.
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Hernandez JF, Secrest JA, Hill L, McClarty SJ. Scientific advances in the genetic understanding and diagnosis of malignant hyperthermia. J Perianesth Nurs 2009; 24:19-31; quiz 32-4. [PMID: 19185818 DOI: 10.1016/j.jopan.2008.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 11/15/2008] [Accepted: 12/03/2008] [Indexed: 02/06/2023]
Abstract
Malignant hyperthermia (MH), a potentially fatal disorder triggered by certain types of general anesthesia, has received much attention in the scientific literature. From the first case report in 1960 until the present, hundreds of studies have been conducted. The diagnosis of MH has evolved from subjective assumptions by family history and clinical diagnosis to more sophisticated laboratory testing. A genetic basis for MH was recognized in the early 1990s and, since then, complex genetic pathways have been demonstrated. The purpose of this paper is to summarize the research literature on what is known scientifically about the diagnosis and genetic basis of MH.
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