Abstract
Two case reports have cited the recreational use of cocaine as possible trigger of a malignant hyperthermia (MH) crisis. We evaluated whether toxic concentrations of cocaine altered the in vitro muscle response to halothane during contracture tests for MH. Twenty-two patients were studied. Muscle biopsies were obtained and first tested for MH susceptibility with 3% halothane and caffeine contracture testing. Ten patients were diagnosed as MH-susceptible and 12 as MH non-susceptible, in accordance with the North American Malignant Hyperthermia Group protocol. Then, muscle strips were exposed to 1% halothane in the presence and absence of 0.1 mmol · L−1 cocaine. Cocaine alone did not affect baseline muscle tension in either group. With 1% halothane, MH non-susceptible muscle showed no contracture with or without cocaine. In contrast, in the presence of 1% halothane, MH-susceptible muscle showed either no change in contracture (six patients), an increase (two patients), or a decrease (two patients) when exposed to cocaine. However, the overall effect of cocaine on muscle contracture in the presence of 1% halothane was insignificant in both groups. We conclude that cocaine, even at toxic levels, does not have a direct effect on skeletal muscle contractility and thus is safe for MH-susceptible patients.
Résumé
Deux observations ont déjà mentionné l’usage illégal de la cocaïne comme cause déclenchante de crises d’hyperthermie maligne (HM). Nous recherchons si des concentrations toxiques de cocaïne pourraient changer in vitro la réponse des tests de contracture musculaire à l’halothane 1% spécifiques pour l’HM. L’étude porte sur vingt-deux patients. Des biopsies musculaires sont d’abord prélevées et soumises à l’épreuve de contracture à l’halothane 3% et à celle de la caféine. Chez dix patients on diagnostique une susceptibilité à l’HM en conformité avec le protocole nord-américain du groupe d’HM alors que 12 patients sont déclarés normaux. Les lambeaux musculaires sont ensuite exposé à l’halothane 1% en présence ou non de cocaïne 0,1 mmol · L−1. L’exposition à la cocaine seule ne change pas la tension musculaire initiale dans les deux groupes. Avec halothane 1%, le muscle non susceptible à l’HM ne présente pas de contracture que ce soit avec ou sans cocaïne. Par contre, avec l’halothane 1%, le muscle susceptible à l’HM en présence de cocaïne montre aucun changement (six patients), une augmentation (deux patients) ou une diminution de la contracture (deux patients). Cependant, en général, l’effet de la cocaïne sur la contracture musculaire en présence de cocaïne 1% est négligeable pour les deux groupes. Nous concluons que la cocaïne, même à concentrations toxiques, n’a pas d’effets directs sur la contractilité du muscle squelettique et ainsi ne présente pas de danger pour les patients susceptibles à l’HM.
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Sato, N., Brum, J.M., Mitsumoto, H. et al. Effect of cocaine on the contracture response to 1% halothane in patients undergoing diagnostic muscle biopsy for malignant hyperthermia. Can J Anaesth 42, 158–162 (1995). https://doi.org/10.1007/BF03028270
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DOI: https://doi.org/10.1007/BF03028270