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Propofol is a 'safe' anaesthetic agent in malignant hyperthermia susceptible patients
A J McKenzie1, K G Couchman, N Pollock
1Department of Anaesthesia and Intensive Care, Palmerston North Hospital, New Zealand.
Abstract:
In this study we investigated in vitro and in vivo effects of propofol in malignant hyperthermia susceptible (MHS) patients in order to assess the safety of propofol infusion as a non-triggering anaesthetic technique for diagnostic and therapeutic procedures. In vitro, human MHS muscle samples were exposed to propofol and changes in (a) baseline tension and (b) contracture tension on exposure to halothane and caffeine were measured. In vivo, (a) anaesthesia was induced in ten muscle biopsy positive MHS patients with propofol 2.5 mg/kg and (b) anaesthesia was produced in five muscle biopsy positive MHS patients with infusions of propofol up to 10 mg/kg/hr. In vitro, human MHS muscle did not develop contractures with propofol alone. Propofol had no significant effect on contracture development in response to halothane and caffeine. In vivo, no evidence of an MH response was detected following induction or maintenance of anaesthesia with propofol. Our results and literature review are in agreement that propofol is a 'safe' induction and maintenance agent in MHS patients. Propofol can be used for muscle biopsy anaesthesia because it does not alter the sensitivity of diagnostic muscle biopsy testing.
Insights
Propofol is safe for malignant hyperthermia susceptible (MHS) patients. This study found propofol does not trigger MHS reactions in vitro or in vivo, making it suitable for anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
- Genetics
Background:
- Malignant hyperthermia (MH) is a severe pharmacogenetic disorder of skeletal muscle.
- Propofol is a common anesthetic agent, but its safety in MH-susceptible (MHS) patients requires careful evaluation.
Purpose of the Study:
- To investigate the in vitro and in vivo effects of propofol in MHS patients.
- To assess the safety of propofol as a non-triggering anesthetic for diagnostic and therapeutic procedures in MHS individuals.
Main Methods:
- In vitro: MHS muscle samples exposed to propofol, measuring baseline and contracture tension with halothane and caffeine.
- In vivo: Anesthesia induced and maintained with propofol in MHS patients undergoing muscle biopsy.
Main Results:
- In vitro, propofol alone did not induce contractures in MHS muscle.
- Propofol did not significantly affect halothane- or caffeine-induced contractures.
- In vivo, no MH responses were observed during propofol induction or maintenance.
Conclusions:
- Propofol is a safe anesthetic agent for induction and maintenance in MHS patients.
- Propofol does not alter the sensitivity of diagnostic muscle biopsy testing for MH.