Frei D, Stowell K M, Langton E E, McRedmond L, Pollock N A, Bulger T F
Anaesthetic Registrar, Department of Anaesthesia and Pain Management, Wellington Regional Hospital, Wellington, New Zealand.
Professor in Biochemistry, Institute of Fundamental Sciences, Massey University, Palmerston North, Manawatu, New Zealand.
Anaesth Intensive Care. 2017 Sep;45(5):611-618. doi: 10.1177/0310057X1704500512.
Testing for malignant hyperthermia in New Zealand involves two tests-in vitro contracture testing of excised lateral quadriceps muscle and DNA analysis. In vitro contracture testing is regarded as the gold standard in malignant hyperthermia diagnosis but several publications have questioned the reliability of a normal result. Analysis of 479 anaesthetic records in 280 patients or their descendants throughout New Zealand who had tested negative for malignant hyperthermia, demonstrated there was no evidence of malignant hyperthermia episodes in this group who had been administered anaesthetic triggering agents. A wide range of anaesthetics were used over the study period. Analysis of each anaesthetic record was undertaken using the malignant hyperthermia grading scale which determines the likelihood that an anaesthetic event represents a malignant hyperthermia episode. Confirmation of the negative results was further supported by normal DNA analysis of patients in 48% of anaesthetics. There are advantages to using inhalational agents in certain situations and although demonstrating a zero risk of a malignant hyperthermia episode is not statistically possible, evidence in this large series suggests that the risk of an episode in these patients is extremely low and may be negligible. We suggest that anaesthetic triggering agents can be used safely in patients with normal in vitro contracture tests, and in their descendants.
新西兰的恶性高热检测包括两项测试——切除的股外侧肌体外挛缩试验和DNA分析。体外挛缩试验被视为恶性高热诊断的金标准，但有几篇出版物对正常结果的可靠性提出了质疑。对新西兰280名患者或其后代的479份麻醉记录进行分析，这些患者的恶性高热检测结果均为阴性，结果显示，在接受麻醉触发剂的这组患者中，没有恶性高热发作的证据。在研究期间使用了多种麻醉剂。使用恶性高热分级量表对每份麻醉记录进行分析，该量表可确定麻醉事件代表恶性高热发作的可能性。48%的麻醉患者DNA分析结果正常，进一步支持了阴性结果。在某些情况下使用吸入剂有其优势，虽然从统计学上证明恶性高热发作的风险为零是不可能的，但这个大型系列研究的证据表明，这些患者发作的风险极低，可能可以忽略不计。我们建议，体外挛缩试验结果正常的患者及其后代可以安全地使用麻醉触发剂。
