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Myotoxicity of local anesthetics is equivalent in individuals with and without predisposition to malignant hyperthermia

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Abstract

Purpose

Malignant hyperthermia (MH) is an inherited muscle disorder caused by abnormal elevations of intracellular calcium (Ca2+) in skeletal muscle. There are several reports of myotoxicity caused by local anesthetics, and the increased intracellular Ca2+ is considered to be an important cause. However, there is insufficient evidence regarding myotoxicity in MH-susceptible individuals when large doses of local anesthetics are administered. This study investigated the effect of MH predisposition on myotoxicity.

Methods

Human skeletal muscle samples were obtained from 22 individuals to determine susceptibility to MH, and were evaluated according to whether their Ca2+-induced Ca2+ release (CICR) rates were accelerated or not. This study was performed using surplus muscle that remained after the CICR rate test. We calculated the 50% effective concentration (EC50) values of three local anesthetics, namely lidocaine, levobupivacaine, and ropivacaine using the ratiometric dye Fura-2 AM. Significance was tested using the unpaired t test.

Results

In the accelerated and unaccelerated groups, respectively, the mean ± SD of the EC50 values were 1.52 ± 0.72 and 1.75 ± 0.37 mM for lidocaine (p = 0.42), 0.72 ± 0.36 and 0.79 ± 0.46 mM for levobupivacaine (p = 0.68), and 1.21 ± 0.35 and 1.62 ± 0.57 mM for ropivacaine (p = 0.06). These values were similar in individuals with and without MH predisposition.

Conclusion

The myotoxicity of local anesthetics was equivalent in individuals with and without predisposition to MH.

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Acknowledgements

A Grant-in-Aid (Grant Number 16K20100) for Scientific Research from the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Sachiko Otsuki, Yuko Noda, Rieko Kanzaki, Hirotsugu Miyoshi & Takashi Kondo

  2. Department of Anesthesiology and Critical Care, Graduate School of Biomedical Sciences, Hirohima University, Hiroshima, Japan

    Toshimichi Yasuda, Hiroshi Hamada & Masashi Kawamoto

  3. Department of Anesthesiology, Hiroshima Prefectural Rehabilitation Center, Higashi-hiroshima, Japan

    Keiko Mukaida

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  1. Sachiko Otsuki
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  2. Toshimichi Yasuda
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  3. Keiko Mukaida
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Correspondence to Sachiko Otsuki.

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Otsuki, S., Yasuda, T., Mukaida, K. et al. Myotoxicity of local anesthetics is equivalent in individuals with and without predisposition to malignant hyperthermia. J Anesth 32, 616–623 (2018). https://doi.org/10.1007/s00540-018-2526-4

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  • DOI: https://doi.org/10.1007/s00540-018-2526-4

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