Hemodynamic and metabolic manifestations of acute endotoxin infusion in pigs with and without the malignant hyperthermia mutation

Citation
Skv. Musley et al., Hemodynamic and metabolic manifestations of acute endotoxin infusion in pigs with and without the malignant hyperthermia mutation, ANESTHESIOL, 91(3), 1999, pp. 833-838
Citations number
21
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIOLOGY
ISSN journal
00033022 → ACNP
Volume
91
Issue
3
Year of publication
1999
Pages
833 - 838
Database
ISI
SICI code
0003-3022(199909)91:3<833:HAMMOA>2.0.ZU;2-4
Abstract
Background: The hypermetabolic state induced by acute endotoxemia and malig nant hyperthermia (MH) may be indistinguishable, The aims of this study wer e (1) to investigate the differences between MH and sepsis, (2) to determin e whether acute endotoxemia can trigger MH, and (3) to establish the effect s of dantrolene in these two disorders. Methods: Three groups of swine were studied. All pigs were invasively monit ored and initially anesthetized with nontriggering agents. A placebo Mil-su sceptible group (n = 5) received normal saline whereas the endotoxin groups (MH-susceptible, n = 6; MH-negative, n = 4) received intravenous endotoxin (250 mu g/kg total) during 2.5 h. Halothane (1.5%) and succinylcholine (2- 4 mg/kg) were then administered, followed by two doses of dantrolene (4 mg/ kg total), Results: Endotoxin infusion resulted in pulmonary hypertension and systemic hypotension in pigs with and without the MH mutation, but did not trigger MH. Halothane and succinylcholine triggered MH, evidenced by a markedly hig her oxygen consumption in the MH-susceptible pigs that received endotoxin(3 25 +/- 196 ml/min) and those that did not (374 +/- 110 ml/min) compared to the MH-negative pigs (69 +/- 15 ml/min, P < 0.0003), as well as muscular ri gidity in the susceptible animals. Dantrolene reversed these changes. Three of the six MH-susceptible pigs that received endotoxin died; two died soon after triggering and one after dantrolene administration, In contrast, non e of the MH-negative pigs or the MH-susceptible pigs that did not receive e ndotoxin died (0 of 3 vs. 3 of 6, P = 0.044). Conclusion: Endotoxemia does not trigger MH, but may worsen outcome if it o ccurs.