Studies on the Prophylaxis, the Diagnosis and the Treatment of Malignant Hyperthermia

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<Studies with the Skinned Fiber Technique> In malignant hyperthermia patients, the rate of Ca^<2+>-induced Ca^<2+> release (CICR) from the sarcoplasmic reticulum (SR) seems to be abnormally potentiated in genetic.This abnormality is observed with the skinned fiber technique. So we studied the effects of drugs used perioperatively on CICR and the rate of CICR of human skeletal muscle with the skinned fiber technique.1) All volatile anesthetics in clinical concentration accelarated the rate of CICR at the mammalian temperature. All local anesthetics in clinical concentration didn't affect the rate of CICR, but according to their effects on the rate of CICR in about one thousand times higher concentration than clinical, the cocal anesthetic were divided into two groups ; CICR accelerators (lidocaime, mepivacaine, bupivacaine, prilocain) and CICR inhibitors (procaine, tetracaine). Muscle relaxants (depolarizing and non-depolarizing) didn't affected the rate of CICR, and all narcotics didn' … More t too.2) In order to determine the standard value of the rate of CICR in human skeletal muscle, in normal 28 volunteers the rates of CICR were measured by skinned fiber technique. No significant difference couldn't be observed by sex and age. So we determined the value of mean<plus-minus>2SD as the normal rang3) The rate of CICR of 116 patients suspected MH were measured. In 16 cases out of 18 fulminant MH cases the rate of CICR potentieted, but in 25 cases out of 27 abortive MH within normal range.<Statistical review of fulminant malignant hyperthermea in Japan>We collected fulminant MH cases reported from 1961 to 1990 in Japan and analyzed them retrospectively.Total number of fulminant MH cases that we could collect were 252, 196 in male and 56 in female.Mortality rate was 34.9%. The mortality rate in patients whose maximum body temperature above 40^ﾟC was 46.2%, but that below 40^ﾟC was 4.4%. The mortality in dantloren-treated patients was lower than one in dantloren-no-treated.In recent years (1986-1990), the mortality decreased to 13.0% and the cases anesthetized by enflurane increased.<Various incidences of fulminant malignant hyperthermia in Japan>The total number of general anesthesias from 1976 to 1987 was 8,900,000 and 140 cases of fulminant MH were reported for the same period. The average incidence was 1 out of 64,000 general anesthesias.The incidence of male MH was 3.6 times greater than that of female MH.Based on the age distribution of general anesthesia and the number of fulminant MH cases, the calculated incidence of fulminant MH was proved to be highest in male twenties (1 : 11,000). Less