Plasma levels of norepinephrine and epinephrine during malignant hyperthermia in susceptible pigs.

Malignant hyperthermia (MH) is a genetic disease of man, swine, dogs, cats, and horses. The syndrome is normally triggered by inhalational anesthetics or the administration of depolarizing muscle relaxants such as succinylcholine or various environmental stress factors. We have used the MH-susceptible pig as an animal model to study the hormonal changes developing during this highly lethal syndrome. High-performance liquid chromatography with electrochemical detection was used for the quantitation of the plasma levels of norepinephrine and epinephrine during MH. This research presents evidence that the rapid release of massive quantities of norepinephrine (up to 108 ng/ml) into the blood stream occurs simultaneously with the initiation of tachycardia which is the herald signal of the onset of MH. Norepinephrine levels exceed epinephrine by a 4:1 ratio early in the syndrome. Even pigs with MH which do not develop the muscle rigor phase have high levels of circulating norepinephrine. Tachycardia, pulmonary hypertension, increased venous oxygen desaturation, and increasing core temperature develop as the syndrome progresses.