Matthew A Timmins1, Henry Rosenberg, Marilyn Green Larach, Carly Sterling, Natalia Kraeva, Sheila Riazi. 1. From the Malignant Hyperthermia Investigation Unit, University Health Network, Toronto, Ontario, Canada (M.A.T., C.S., N.K., S.R.); Department of Anesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada (M.A.T., C.S., N.K., S.R.); Malignant Hyperthermia Association of the USA, Sherburne, New York, and Saint Barnabas Medical Center, Medical Education, Livingston, New Jersey, and Rutgers New Jersey Medical School, Newark, New Jersey (H.R.); and North American Malignant Hyperthermia Registry, Pittsburgh, Pennsylvania (M.G.L.).
Abstract
BACKGROUND: Malignant hyperthermia (MH) is triggered by reactions to anesthetics. Reports link nonanesthetic-induced MH-like reactions to a variety of disorders. The objective of the authors was to retrospectively investigate the reasons for referrals for MH testing in nonanesthetic cases and assess their phenotype. In addition, the response to the administration of oral dantrolene in nonanesthetic probands with positive caffeine-halothane contracture test (CHCT) was investigated. METHODS: Following institutional research ethics board approval, probands without reaction to anesthesia, who underwent CHCT, were selected. Clinical details and response to dantrolene were analyzed. RESULTS: In total, 87 of 136 (64%) patients referred for nonanesthetic indications tested positive to the CHCT. Of these, 47 with a high creatine kinase (CK), 9 with exercise-induced rhabdomyolysis and/or exercise intolerance, 2 with high CK and exercise-induced rhabdomyolysis and/or exercise intolerance, 15 with postviral chronic fatigue, and 14 with muscle weakness of unknown etiology had a positive CHCT. These patients had a higher CK compared with those with negative CHCT. Oral dantrolene improved the musculoskeletal symptoms in 28 of 34 (82%) CHCT-positive patients. Response to treatment was associated with a significantly higher pretreatment CK and a greater posttreatment CK reduction. CONCLUSIONS: A positive CHCT may represent more than simply an anesthetic-related disorder. Individuals with positive CHCTs may exhibit muscle symptoms without exposure to MH-triggering anesthetics. Oral dantrolene may be useful in alleviating these symptoms.
BACKGROUND:Malignant hyperthermia (MH) is triggered by reactions to anesthetics. Reports link nonanesthetic-induced MH-like reactions to a variety of disorders. The objective of the authors was to retrospectively investigate the reasons for referrals for MH testing in nonanesthetic cases and assess their phenotype. In addition, the response to the administration of oral dantrolene in nonanesthetic probands with positive caffeine-halothanecontracture test (CHCT) was investigated. METHODS: Following institutional research ethics board approval, probands without reaction to anesthesia, who underwent CHCT, were selected. Clinical details and response to dantrolene were analyzed. RESULTS: In total, 87 of 136 (64%) patients referred for nonanesthetic indications tested positive to the CHCT. Of these, 47 with a high creatine kinase (CK), 9 with exercise-induced rhabdomyolysis and/or exercise intolerance, 2 with high CK and exercise-induced rhabdomyolysis and/or exercise intolerance, 15 with postviral chronic fatigue, and 14 with muscle weakness of unknown etiology had a positive CHCT. These patients had a higher CK compared with those with negative CHCT. Oral dantrolene improved the musculoskeletal symptoms in 28 of 34 (82%) CHCT-positive patients. Response to treatment was associated with a significantly higher pretreatment CK and a greater posttreatment CK reduction. CONCLUSIONS: A positive CHCT may represent more than simply an anesthetic-related disorder. Individuals with positive CHCTs may exhibit muscle symptoms without exposure to MH-triggering anesthetics. Oral dantrolene may be useful in alleviating these symptoms.
Authors: Yuri Hosokawa; Douglas J Casa; Henry Rosenberg; John F Capacchione; Emmanuel Sagui; Sheila Riazi; Luke N Belval; Patricia A Deuster; John F Jardine; Stavros A Kavouras; Elaine C Lee; Kevin C Miller; Sheila M Muldoon; Francis G O'Connor; Scott R Sailor; Nyamkhishig Sambuughin; Rebecca L Stearns; William M Adams; Robert A Huggins; Lesley W Vandermark Journal: J Athl Train Date: 2017-03-07 Impact factor: 2.860
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