Desflurane is a trigger of malignant hyperthermia in susceptible swine.
Desflurane (difluoromethyl 1-fluoro 2,2,2-trifluoroethyl ether: CF2-H-O-CFH-CF3) is a potent inhalation anesthetic agent being investigated for possible clinical use. The authors examined the effects of this agent on normal swine and those from a special breeding program that were considered purebred for susceptibility to malignant hyperthermia (MH). Animals were exposed to 1 or 2 MAC or both doses of desflurane and observed for changes in end-tidal CO2, arterial blood gases, lactate, catecholamines, core temperature, blood pressure, and heart rate. All normal swine tolerated exposure to desflurane without clinical signs of MH, but significant changes in heart rate and blood pressure were noted. In contrast, of six MH susceptible swine tested, two had unequivocal MH reactions to deflurane, defined by significant increases of end-tidal CO2 (greater than 50 mmHg), an increase in PaCO2 (greater than 70 mmHg), a decrease in blood pH (less than 7.30), an increase in blood lactate concentration, and an increase in core temperature. Two other susceptible swine showed equivocal signs of MH but not until desflurane had been administered for 40-60 min. Finally, two other susceptible swine showed no signs of MH after 60 min of exposure to 2 MAC desflurane. These latter four animals all developed episodes of MH immediately after intravenous succinylcholine (2 mg/kg). The increased PaCO2, blood lactate concentrations, and temperature, and the decrease in pH induced by desflurane, were successfully treated with dantrolene and supportive measures. All surviving animals were biopsied 1 to 2 weeks after the exposure to desflurane for in vitro contracture testing to confirm MH susceptibility.(ABSTRACT TRUNCATED AT 250 WORDS)
Wedel
D J
DJ
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905.
Iaizzo
P A
PA
Milde
J H
JH
D000769:Anesthesia, Inhalation; D000818:Animals; D001769:Blood; D001831:Body Temperature / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D000077335:Desflurane; D004198:Disease Susceptibility; D006863:Hydrogen-Ion Concentration; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000633:toxicity; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008305:Malignant Hyperthermia / Q000503:physiopathology*; D010313:Partial Pressure; D013552:Swine
D007773:Lactates; D002245:Carbon Dioxide; D019344:Lactic Acid; D000077335:Desflurane; D007530:Isoflurane