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[Use of Diprivan in muscular diseases and malignant hyperthermia]
1Département d'Anesthésie-Réanimation Chirurgicale I, Hôpital B, CHRU Lille.
Abstract:
An unknown myopathy can be revealed by the administration of an anaesthetic agent. The symptoms are those of malignant hyperpyrexia (MH). The MH phenotype can be detected by means of contracture tests in vitro. All anaesthetics, excepting the triggering agents, can be given. The safety of propofol as an induction and maintenance agent in this category of patients has been demonstrated. When the presence of a myopathy is known before an anaesthetic, the administration of succinylcholine associated or not with a halogenated inhalational agent carries a risk of severe complication. Among the anaesthetic agents having little effect on the skeletal muscle, propofol seems interesting, also because of its pharmacokinetic properties. Myopathy is difficult to diagnose, either because the patient undergoes surgery before being symptomatic or because he is only a carrier of MH. In case of an abnormal reaction following the administration of recognized triggering agents or the occurrence of MH, the procedure should be discontinued. In case of absolute necessity, the procedure may be continued but with non-triggering agents only.
Insights
Anesthetic agents can reveal unknown myopathies presenting as malignant hyperpyrexia (MH). Propofol is a safe anesthetic option for patients with myopathy or MH susceptibility, avoiding triggering agents.
Area of Science:
- Anesthesiology
- Neuromuscular Disorders
- Pharmacology
Context:
- Anesthesia administration can unmask underlying myopathies, leading to malignant hyperpyrexia (MH).
- Diagnosing myopathy pre-operatively is challenging, as patients may be asymptomatic carriers or present only after anesthesia.
- Malignant hyperpyrexia (MH) is a severe pharmacogenetic disorder of skeletal muscle.
Purpose:
- To review the anesthetic management of patients with undiagnosed myopathies or known susceptibility to malignant hyperpyrexia (MH).
- To highlight the safety and efficacy of propofol in this patient population.
- To discuss the risks associated with triggering agents like succinylcholine and halogenated agents.
Summary:
- Myopathies can be revealed by anesthetic agents, manifesting as malignant hyperpyrexia (MH).
- In vitro contracture tests can detect the MH phenotype.
- Propofol demonstrates safety as an induction and maintenance agent in patients with myopathy or MH susceptibility.
- Succinylcholine and halogenated agents pose significant risks for patients with myopathy or MH.
Impact:
- Provides guidance for safe anesthetic practices in patients with undiagnosed myopathies or MH susceptibility.
- Emphasizes the importance of recognizing MH symptoms and discontinuing triggering agents if suspected.
- Suggests propofol as a preferred anesthetic agent due to its minimal effect on skeletal muscle and favorable pharmacokinetics.