Fulminant-type malignant hyperthermia in Japan: cumulative analysis of 383 cases

Abstract

We investigated the transition of clinical signs of fulminant-type malignant hyperthermia (f-MH) by analyzing a database consisting of 383 cumulative cases of f-MH from 1961 to 2004. The cases were divided by time period into group 1 (1961-1984), group 2 (1985-1994), and group 3 (1995-2004). The variables considered were age, sex, type of agents used (succinylcholine and volatile anesthetics), dantrolene administration, clinical signs, laboratory data, and mortality. The level of statistical significance was considered to be less than 5%. Groups 1, 2, and 3 consisted of 196, 127, and 60 cases, respectively. In groups 1, 2, and 3, the rates of dantrolene administration were 18.4%, 93.6%, and 86.7%; the rates of occurrence of ventricular arrhythmia were: 75.2%, 55.6%, and 35.0%; and the rates of generalized muscle rigidity were 64.7%, 60.9%, and 23.9%, respectively. The mortality rate decreased over time, from 42.3% in group 1, to 15.0% in group 2 and group 3. We considered that this decrease occurred because of the increased use of dantrolene and the early diagnosis of malignant hyperthermia in the latter two groups.

Malignant Hyperthermia in Canada

“…Our study of 129 index adverse anesthetic events suggestive of possible MH susceptibility, showed that they occurred predominantly in younger male patients and that the most common signs were hyperthermia, tachycardia, and hypercarbia. This finding, also made in the previous studies in other populations, 7,13 indicates that early dantrolene administration reduces the incidence of complications. 13 When dantrolene was given, we observed a higher complication rate when the time between the first clinical sign and dantrolene use was longer.…”

Anesthetic‐and heat‐induced sudden death in calsequestrin‐1‐knockout mice

“…Other studies found males representing 78% of the 181 MH cases in the North American MH Registry (NAMHR) (52) and 73% of the 308 NAMHR patients included in a recent MH recrudescence study (53). A similar male prevalence (ϳ4:1) was observed in an epidemiological study of 383 MH cases in Japan from 1961 to 2004 (54). Moreover, EHS is also reported to be much more common in young men and quite rare in women (55).…”

Use of the caffeine-halothane contracture test for the diagnosis of malignant hyperthermia in Brazil

“…A biopsy of the vastus lateralis muscle approximately 3.5 cm long, 2.0 cm wide and 1.5 cm deep was performed under local anesthesia of the femoral and femoral-cutaneous nerves with a mixture of lidocaine (1.5%) and epinephrine (1:200,000) in adults, and under general anesthesia with a combination of propofol (1.5 mg·kg -1 ·min -1 iv bolus followed by infusion of 100 µg·kg -1 ·min -1 ) and remifentanyl (2 µg/ kg iv bolus) in children less than 14 After the end of the caffeine contracture test, the chambers were carefully washed to eliminate contamination with caffeine and, using the same procedure, 3-4 additional muscle fragments were prepared for isometric tension recording. After a period of adaptation, a gas mixture containing 3% halothane (Cristália, Brazil) and carbogen was bubbled into the Ringer-Krebs solution for 10 min.…”

“…After the clinical introduction of dantrolene sodium to treat MH, mortality decreased from 75% to less than 5% (12). However, the mortality of MH is increasing in the United States (11.7%) (13), Japan (15%) (14) and Taiwan (28.7%) (15). No data regarding MH incidence or death have been reported in Brazil.…”