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ANESTHETIC PHARMACOLOGY

Volatile Anesthetics and Succinylcholine in Cardiac Ryanodine Receptor Defects

Heikki Swan, MD^*, Päivi J. Laitinen, MSc, and Lauri Toivonen, MD^*

Departments of *Cardiology and Medicine, Helsinki University Central Hospital, Helsinki, Finland

Address correspondence and reprint requests to Heikki Swan, MD, Helsinki University Hospital, Department of Cardiology, PL 340, Haartmaninkatu 4, FIN-00029 HUS, Helsinki, Finland. Address e-mail to heikki.swan{at}helsinki.fi

Familial polymorphic (catecholaminergic) ventricular tachycardia is an arrhythmogenic cardiac disorder caused by mutations of the myocardial isoform of the ryanodine receptor gene (RyR2). Mutations of the corresponding gene in the skeletal muscle (RyR1) predispose its carriers to malignant hyperthermia upon use of volatile anesthetics or succinylcholine, which further deteriorate the inherited intracellular calcium release disorder. We report a series of patients with cardiac RyR defects who underwent general anesthesia without complications. Succinylcholine and volatile anesthetics did not have a clinically significant effect on RyR2 defects.

IMPLICATIONS: We report a series of patients with cardiac ryanodine receptor (RyR) defects who had general anesthesia. Succinylcholine and volatile anesthetics do not seem to have a clinically significant effect on cardiac RyR2. This suggests an isoform-specific effect of these compounds on the RyR1 calcium channel, the mutations of which are associated with malignant hyperthermia.