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Malignant hyperpyrexia occurring during general anaesthesia is fatal in over 70% of cases.' Most anaesthetic agents have been suspected as triggering agents for the syndrome but the two drugs most commonly reported are halothane and suxamethoniuni. Since the early reports of a genetic anomaly underlying the several family case histories have been r e p~r t e d . " -~ The inherited defect is thought to be associated with one, or more likely, several subclinical myopathies. The family studies have been based on the finding of raised serum creatine phosphokinase levels (CPK) in survivors of the syndrome and in many of their relatives. Within 5 months of each other two separate families attended the Dental Department for Children with requests for multiple extractions of primary teeth. Their case histories are of interest in that they represent a potential hazard in outpatient dental anaesthesia. They also illustrate many of the difficulties associated with the general management of families suspected to be at risk from malignant hyperpyrexia. Case histories Ftmiilj, BIn January 1972 a healthy. white, 7;-year-old girl attended the Dental Department for Children complaining of pain of 2 months duration in all four quadrants. Clinical and radiographic examination revealed that multiple extractions were necessary and a general anaesthetic was suggested. Mrs B was extremely concerned and anxious and asked whether the most painful tooth could not be removed under local analgesia: when pressed for a reason for her attitude she finally admitted that she was afraid of general anaesthesia. This was because she had lost a 14-year-old son who had died under anaesthesia 2+ years previously, following a motorcycle accident in which her husband had been killed. She then produced a letter which had been sent t o her by the