Malignant hyperthermia sevoflurane

Halothane has the highest blood/gas partition coefficient of the volatile anaesthetic agents and recovery from halothane anaesthesia is comparatively slow. It is pleasant to breathe and is second choice to sevoflurane for inhalational induction of anaesthesia. Halothane reduces cardiac output more than any of the other volatile anaesthetics. It sensitises the heart to the arrhythmic effects of catecholamines and hypercapnia arrhythmias are common, in particular atrioventricular dissociation, nodal rhythm and ventricular extrasystoles. Halothane can trigger malignant hyperthermia in those who are genetically predisposed (see p. 363). 

Malignant hyperthermia has occurred in people treated with sevoflurane. 

A 28-year-old man, who developed malignant hyperthermia after anesthesia induced with isoflurane and maintained with sevoflurane, died 4 days later, despite cooling and intravenous dantrolene (49). 

Other cases of malignant hyperthermia have been reported in patients who received sevoflurane (50,51). Although it is highly likely that sevoflurane caused malignant hyperpyrexia in these cases, suxamethonium was also given and was also a suspect. 

In more than 3000 cases in Japan, there were two cases of malignant hyperthermia, one fatal (49). In this case isoflurane had been used early in anesthesia, and could have been at least in part responsible. There was some reason to consider that the patient, a 12-year-old girl, had a family propensity to malignant hyperthermia, as indicated by higher resting Pi/Pcr values. However, sevoflurane itself can trigger malignant hyperthermia in swine (54). 

Otsuka H, Komura Y, Mayumi T, Yamamura T, Kemmotsu O, Mukaida K. Malignant hyperthermia during sevoflurane anesthesia in a child with central core disease. Anesthesiology 1991 75(4) 699-701. 

Massaro F, De Klerk DYJ, Snoeck MMJ. A case of malignant hyperthermia during use of sevoflurane. Ned Tijdschr Anesthesiol 2001 14 71-3. 

Baris S, Karakaya D, Guldogus F, Sarihasan B, Tekat A. A case of malignant hyperthermia during sevoflurane anesthesia. Turk J Med Sci 2001 31 171-3. 

Shulman M, Braverman B, Ivankovich AD, Gronert G. Sevoflurane triggers malignant hyperthermia in swine. Anesthesiology 1981 54(3) 259-60. 

Body temperature Sevoflurane has once again been linked to malignant hyperthermia, in a 37-year-old man in whom the genetic link was found in the ryanodine receptor [10 ]. The current recommendations of the European Malignant Hyperthermia Group are to perform open muscle biopsy followed by an in vitro contracture test and molecular... 

Body temperature Malignant hyperthermia occurred 3 hours after the start of an operation for esophageal resection in an 82-year-old man after anesthesia induced with propofol and suxamethonium and maintained with sevoflurane [6 ]. Masseter spasm was not a feature. End-tidal CO2 rose to 55 mmHg and body temperature exceeded 39.0°C. The patient responded promptly to dantrolene. Reports of malignant hyperthermia in patients over the age of 80 years are unusual. Both suxamethonium and sevofiur-ane are potent triggers. 

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