Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation

Figure 1 Functional implication of RY1/DHPR receptor mutations after exposure to volatile anesthetics. The action potential generated in the motor endplate is propagated along the sarcolemma and down the T-tubules, to be captured by the voltage sensitive dihydropyridine receptor. The depolarization-induced conformational change in this receptor in turn results in the opening of the RYR1 calcium-channel and calcium release from the SR. Mutations in the ryanodine-dihydropyridine receptor complex upon exposure to inhalational anesthetics lead to a “longer open state” of RYR1, massive calcium release from the SR, and eventually widespread muscle breakdown.