Abstract
The caffeine contracture test is the most commonly used method of diagnosing malignant hyperthermia. We have examined some factors which may influence the results of this test. These have included the temperature of the bathing solution, the size of the muscle fascicles, and the combined effect of the passage of time and prior equilibration with caffeine or with caffeine plus halothane. For both malignant hyperthermic susceptible (MHS) and normal fascicles, caffeine contractures were greater at 37° C than at 22° C, while halothane and caffeine plus halothane contractures were similar at 37° C and at 22° C. Good differentiation between the normal and the MHS fascicles were observed at both temperatures although the discrimination was slightly, although not always significantly, better at 22° C. The weight, length or diameter of the fascicles had little or no effect on the height of the caffeine or the caffeine plus halothane contractures. We compared caffeine plus halothane contractures exhibited by newly prepared muscle fascicles with caffeine plus halothane contractures manifested by fascicles which had already been equilibrated with either caffeine alone or with caffeine and halothane for at least one hour. Differences in contracture heights among the techniques were small and often not significant, particularly at 37° C. The greatest discrimination between the MHS and the normal muscle fascicles was provided by determining the caffeine plus halothane contracture curves at 22° C, using muscle fascicles which had previously been equilibrated with incremental doses of caffeine in the absence of halothane. Slightly less accurate but still reasonably satisfactory results were also obtained at 37° C using muscle strips which were either freshly prepared or which had prior exposure to caffeine or to caffeine in combination with halothane and, at 22° C, using either newly prepared muscle or muscle which had already been equilibrated with caffeine plus halothane. The widest differentiation between the MHS and the normal muscle was given by the caffeine plus halothane contractures and the least by the halothane contractures. MHS patients whose muscle fascicles exhibited greater than normal caffeine plus halothane contractures but normal caffeine contractures and normal halothane contractures had had the most mild clinical reactions. On the other hand MHS patients whose muscle fascicles demonstrated halothane contractures, caffeine contractures and caffeine plus halothane contractures which were all greater than normal had had the most severe reactions. It is concluded, therefore, that if the amount of muscle available is very small, a satisfactory caffeine contracture test can still be performed by doing the various parts of the test sequentially on the same fascicle. If the time available for performing the test is limited, then the several parts of the test should rather be performed simultaneously on separate muscle fascicles.
Résumé
Le test à la caféine est la méthode la plus courante pour établir le diagnostic ďhyperthermic maligne. Nous avons étudié certains facteurs susceptibles de modifier les résultats, à savoir la température de la solution où baigne le spécimen musculaire, le calibre des fibres musculaires, et les effets combinés de la durée ďexposition et atteinte ďéquilibre avec la caféine ou la caféine associée à ľhalothane. Pour la fibre normale comme pour celle de sujets susceptibles de présenter de ľhyperthermie maligne, les contractures étaient plus importantes à 37° qu’à 22° C. Les réponses étaient semblables aux deux températures si ľhalothane était utilisé. On pouvait bien différencier le muscle normal de ľanormal aux deux températures bien que la différence était légèrement plus visible (pas toujours de façon significative) è 22° qu’à 37° C. Le poids, la longueur et le diamàtre des fibres n’avaient pas ou peu ďeffet sur le résultat du test. Nous avons comparé les résultats du test à la caféine-halothane sur des fibres qui venaient ďêtre préparées avec ceux observés lorsque les fibres avaient été équilibrées par une heure ďexposition à la solution de caféine ou de caféine-halothane. Les différences étaient petites et souvent non significatives, en particulier à 37° C. Les meilleurs conditions pour différencier la fibre normale de ľanormale se retrouvaient en établissant la réponse à la cafàine-halothane à 22° C avec des fibres équilibrées au préalable à des doses progressives de caféine sans halothane. On obtenait des résultats légèrement moins précis mais encore acceptables à 37° C avec des fibres fraîchement préparées ou équilibrées à la caféeine-halothane. La meilleure différenciation entre la normalité et ľanormalité était obvservée avec ľassociation caféine-halothane et la moins bonne avec la contracture à ľhalothane. Les patients susceptibles à ľhyperthermic présentant une réponse à la caféine-halothane plus grande que la normale, mais une réponse normale à la caféine ou à ľhalothane isolés, présentment les phénomènes cliniques les plus discrets. Ceux dont les résultats étaient supérieurs é la normale avec la caféine, ľhalothane et ľassociation caféine-halothane, présentaient les manifestations cliniques les plus graves. II est conclu que si la quantité de muscle disponible est petite, on peut tout de même obtenir un test valable en procédant aux différentes étapes de façon séquentielle. Si ľurgence exige des résultats rapides, il vaut mieux procéder simultanément aux différentes étapes en utilisant des fibres séparées.
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Britt, B.A., Endrenyi, L., Scott, E. et al. Effect of temperature, time and fascicle size on the caffeine contracture test. Canad. Anaesth. Soc. J. 27, 1–11 (1980). https://doi.org/10.1007/BF03006840
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DOI: https://doi.org/10.1007/BF03006840