title: Effects of caffeine, halothane, and 4-chloro-m-cresol on skeletal muscle lactate and pyruvate in malignant hyperthermia-susceptible and normal swine as assessed by microdialysis.
abstract: BACKGROUND
  Skeletal muscle fibers from malignant hyperthermia (MH)-susceptible humans and swine are markedly more sensitive to ryanodine receptor (RyR1) agonists than those from normal individuals. Reproducible shifts in the dose-response of skeletal muscle to caffeine and halothane are the basis of the current in vitro diagnostic caffeine-halothane contracture test. In an attempt to develop a less invasive MH diagnostic test, the authors determined the effects of RyR1 agonists (caffeine, 4-chloro-m-cresol [4CmC], and halothane) on the adductor muscle with respect to the lactate-pyruvate (L/P) system that was percutaneously dialyzed using a microdialysis technique in homozygous MH-susceptible compared with normal swine.
  
  
  METHODS
  Animals were anesthetized (ketamine-propofol) and artificially ventilated. Sets of six CMA/20 microdialysis catheters were implanted; each catheter was perfused with different RyR1 agonist concentrations. After a 30-min equilibration after implantation, one of the catheters was perfused (2 microl/min) with vehicle (0.9% saline or lipid emulsion), and the other five were perfused with caffeine (1-64 mM), 4CmC (0.1-8 mM), or halothane (prepared in lipid emulsion; 10-500 mM). Outflow dialysate fractions collected at 10-min intervals and L/P parameters were measured enzymatically.
  
  
  RESULTS
  Only in the MH-susceptible group did all RyR1 agonists increase dialysate L/P in a dose-dependent manner. The dose-effect relations were most prominent with 4CmC. With the halothane lipid emulsion, data scatter was high compared with that of the caffeine group and especially the 4CmC group. There were no signs of global muscle rigidity, systemic hypermetabolism, or a clinical MH episode during microdialysis RyR1 perfusion.
  
  
  CONCLUSIONS
  The authors data demonstrate that the in vivo muscle microdialysis of the porcine L/P system reveals distinct differences between MH-susceptible and MH-normal muscle, especially in response to highly specific RyR1 agonists such as 4CmC. The microdialysis L/P technique seems to have an MH diagnostic potential in the clinical setting.
authors.affiliation: Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA. sbina@usuhs.mil
authors.forename: Saiid
authors.initials: S
authors.lastname: Bina
authors.forename: George
authors.initials: G
authors.lastname: Cowan
authors.forename: John
authors.initials: J
authors.lastname: Karaian
authors.forename: Sheila
authors.initials: S
authors.lastname: Muldoon
authors.forename: Paul
authors.initials: P
authors.lastname: Mongan
authors.forename: Rolf
authors.initials: R
authors.lastname: Bünger
mesh_terms: D000768:Anesthesia, General; D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous; D000818:Animals; D001784:Blood Gas Analysis; D002110:Caffeine / Q000494:pharmacology*; D000697:Central Nervous System Stimulants / Q000494:pharmacology*; D003402:Creatine Kinase / Q000097:blood; D003408:Cresols / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004573:Electrolytes / Q000378:metabolism; D005947:Glucose / Q000378:metabolism; D006221:Halothane / Q000494:pharmacology*; D007649:Ketamine; D019344:Lactic Acid / Q000378:metabolism*; D008305:Malignant Hyperthermia / Q000235:genetics / Q000378:metabolism*; D017551:Microdialysis; D018482:Muscle, Skeletal / Q000187:drug effects / Q000378:metabolism*; D015742:Propofol; D019289:Pyruvic Acid / Q000378:metabolism*; D019837:Ryanodine Receptor Calcium Release Channel / Q000187:drug effects; D013552:Swine
chemical_list: D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000697:Central Nervous System Stimulants; D003408:Cresols; D004573:Electrolytes; D019837:Ryanodine Receptor Calcium Release Channel; D019344:Lactic Acid; C006984:chlorocresol; D002110:Caffeine; D007649:Ketamine; D019289:Pyruvic Acid; D003402:Creatine Kinase; D005947:Glucose; D006221:Halothane; D015742:Propofol