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The severity of sevoflurane-induced malignant hyperthermia

T Migita1, K Mukaida, M Kobayashi

  • 1Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan. migitataka@hiroshima-u.ac.jp

Acta Anaesthesiologica Scandinavica
|November 19, 2011
PubMed
Abstract

Insights

Malignant hyperthermia (MH) triggered by sevoflurane or isoflurane showed no significant clinical differences. This study found no evidence that sevoflurane is a weaker triggering agent for MH in clinical anesthesia settings.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Medical Genetics

Background:

  • Malignant hyperthermia (MH) is a life-threatening pharmacogenetic disorder of skeletal muscle.
  • It is triggered by volatile anesthetics and succinylcholine during general anesthesia.
  • Sevoflurane is considered a weak triggering agent in animal models, necessitating clinical evaluation.

Purpose of the Study:

  • To compare the clinical severity of malignant hyperthermia (MH) triggered by sevoflurane versus isoflurane.
  • To investigate whether sevoflurane is a weaker triggering agent for MH in human patients.

Main Methods:

  • Analysis of 147 'very likely' or 'almost certain' MH cases from the Japanese MH database (1990-2009).
  • Comparison of 48 cases triggered by sevoflurane without succinylcholine (S-SCh (-)) and 30 by isoflurane without succinylcholine (I-SCh (-)).
  • Evaluation of outcomes, MH Clinical Grading Scale (CGS) scores, onset times, and clinical signs using statistical tests.

Main Results:

  • Mortality rates were similar: 8.3% for sevoflurane and 10.0% for isoflurane (P=0.803).
  • No significant differences were observed in CGS scores (53.4 vs 52.3, P=0.691) or CGS ranks between the groups.
  • Median onset times for MH were comparable: 72.5 minutes for sevoflurane and 65.0 minutes for isoflurane (P=0.890).

Conclusions:

  • The clinical severity of MH triggered by sevoflurane and isoflurane did not differ significantly.
  • There is no clinical evidence to support the hypothesis that sevoflurane is a weaker triggering agent for MH compared to isoflurane.

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