Annotation

The HCSC product monograph warns that individuals with a genetic predisposition to malignant hyperthermia are at an elevated risk of developing malignant hyperthermia, and that patients with Duchenne's Muscular Dystrophy are at an elevated risk of developing hyperkaelemia if administered desflurane, or other potent inhalational anesthetics.

Specific variants in the RYR1 and CACNA1S genes are associated with risk of malignant hyperthermia in individuals administered potent inhalational anesthetics, such as desflurane. Although the product monograph for desflurane (SUPRANE) does not specifically mention genetic testing, it states that desflurane is contraindicated in individuals with known to have a genetic predisposition to malignant hyperthermia.

Excerpts from the desflurane (SUPRANE) product monograph

SUPRANE (desflurane) anesthesia is contraindicated in subjects known to be susceptible to MH.

In susceptible individuals, SUPRANE (desflurane) anesthesia may trigger a skeletal muscle hypermetabolic state leading to high oxygen demand and the clinical syndrome known as malignant hyperthermia.

The most serious reported adverse events in alphabetical order are apnea, bronchospasm, cardiac arrest, hepatic failure, hyperkalemia, hypotension, malignant hyperthermia, and respiratory depression.

Perioperative Hyperkalemia: Use of inhaled anesthetic agents, including desflurane, has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias, some fatal, in patients during the postoperative period. Patients with latent as well as overt muscular dystrophies, particularly Duchenne Muscular Dystrophy, appear to be most vulnerable. Concomitant use of succinylcholine has been associated with most, but not all, of these cases.

For the complete product monograph text with sections containing pharmacogenetic information highlighted, see the desflurane product monograph

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