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Masseter muscle rigidity and malignant hyperthermia susceptibility.

H Rosenberg, J E Fletcher

    Anesthesia and Analgesia
    |February 1, 1986
    PubMed
    Summary

    Masseter muscle rigidity (MMR) after succinylcholine is a strong indicator of malignant hyperthermia (MH) susceptibility. Patients with MMR should be tested for MH and myopathies, and succinylcholine avoided in future anesthetics.

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    Area of Science:

    • Anesthesiology
    • Pharmacology
    • Genetics

    Background:

    • Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder of skeletal muscle.
    • Masseter muscle rigidity (MMR) is a potential adverse reaction to succinylcholine, an anesthetic muscle relaxant.
    • The association between MMR and MH susceptibility requires further investigation.

    Purpose of the Study:

    • To evaluate the incidence of MH susceptibility in patients experiencing MMR after succinylcholine administration.
    • To identify clinical and biochemical markers associated with MH susceptibility in this patient cohort.

    Main Methods:

    • Seventy-seven patients with MMR post-succinylcholine underwent in vitro halothane and caffeine contracture testing for MH susceptibility.
    • Serum creatine phosphokinase (CPK) levels were measured perioperatively.

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  • Patients were assessed for underlying myopathies.

    • Main Results:

    • Thirty-nine of 77 patients (50.6%) were diagnosed as MH-susceptible.
    • No demographic or surgical factors differentiated MH-susceptible from nonsusceptible patients.
    • Perioperative CPK levels ≥ 20,000 IU within 24 hours of MMR (without myopathy) were observed in 6/30 MH-susceptible patients but none of the nonsusceptible patients.

    Conclusions:

    • MMR following succinylcholine administration is a presumptive sign of MH susceptibility.
    • Elevated perioperative CPK levels (≥ 20,000 IU) are highly suggestive of MH susceptibility.
    • Patients with MMR warrant evaluation for MH susceptibility and myopathies; succinylcholine should be avoided in subsequent anesthetics.