Screening for malignant hyperpyrexia

Skeletal muscle from normal human subjects produced linear contracture responses in vitro to caffeine at concentrations of between 4 and 32 mmol/litre. In the presence of 0.4% halothane, caffeine contractures were greater but the magnitude of halothane potentiation decreased as the caffeine concentration was increased. The contractures produced by caffeine 4 and 8 mmol/litre at 37 degrees C were significantly reduced by decreasing the temperature of the incubation solution to 25 degrees C. Among 57 normal subjects, 18% had fibres which responded to halothane treatment with contracture. On the basis of these findings, it is suggested that screening for malignant hyperpyrexia by in vitro pharmacological testing of skeletal muscle should be carried out at 37 degrees C, and should include exposure of the sample to halothane, caffeine, suxamethonium and potassium rather than to halothane alone.