Impact of statin intake on malignant hyperthermia: an in vitro and in vivo swine study

Asensio Gonzalez, Tinen L. Iles, Paul A. Iaizzo, Oliver Bandschapp

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1 Scopus citations


Background: Statin intake is associated with muscular side effects, among which the unmasking of latent myopathies and of malignant hyperthermia (MH) susceptibility have been reported. These findings, together with experimental data in small animals, prompt speculation that statin therapy may compromise the performance of skeletal muscle during diagnostic in vitro contracture tests (IVCT). In addition, statins might reduce triggering thresholds in susceptible individuals (MHS), or exacerbate MH progression. We sought to obtain empirical data to address these questions. Methods: We compared the responses of 3 different muscles from untreated or simvastatin treated MHS and non-susceptible (MHN) pigs. MHS animals were also invasively monitored for signs of impending MH during sevoflurane anesthesia. Results: Muscles from statin treated MHS pigs responded with enhanced in vitro contractures to halothane, while responses to caffeine were unaltered by the treatment. Neither agent elicited contractures in muscles from statin treated MHN pigs. In vivo, end- tide pCO2, hemodynamic evolution, plasma pH, potassium and lactate concentrations consistently pointed to mild acceleration of MH development in statin-treated pigs, whereas masseter spasm and rigor faded compared to untreated MHS animals. Conclusions: The diagnostic sensitivity and specificity of the IVCT remains unchanged by a short-term simvastatin treatment in MHS swine. Evidence of modest enhancement in cardiovascular and metabolic signs of MH, as well as masked pathognomonic muscle rigor observed under simvastatin therapy suggest a potentially misleading influence on the clinical presentation of MH. The findings deserve further study to include other statins and therapeutic regimes.

Original languageEnglish (US)
Article number270
JournalBMC Anesthesiology
Issue number1
StatePublished - Oct 23 2020

Bibliographical note

Funding Information:
The authors thank Charles Soule, M.S. for his help with the in vitro studies; and Gary Williams for support with digital data acquisition. This work shall be attributed to: Department of Surgery and Integrative Biology and Physiology, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

Publisher Copyright:
© 2020, The Author(s).


  • MHS swine
  • Malignant hyperthermia
  • Muscle disease
  • Statin medication

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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