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Spectrum of susceptibility to malignant hypertherrniadiagnostic dilemma. Anesth Analg 1983;62:545-52. Utilizing established in vitro muscle contracture tests, we have identified three diagnostic contracture phenotypes for malignant hyperthermia susceptibility (MHS) among 103 patients. Phenotype H is an unequivocal diagnostic result for MHS, as is the nonsusceptible phenotype N . The third diagnostic group, phenotype K, represents an equivocal diagnostic response. To provide a basis for understanding relationships between contracture phenotypes and MHS, pigs with phenotypes H , K , and N were exposed to a standardized anesthetic protocol for assessing MHS. During the anesthetic challenge, phenotype H pigs developed a more severe form of the M H syndrome than did phenotype K pigs. Comparing phenotype H v K average responses, Vo, increased four-v twofold; lactate increased 13-v 9-fold; and temperature increased 41.7"C v 39.2"C, respectively. These values either had no change or decreased in the phenotype N pigs. Results of this study suggest that a spectrum of MHS exists among the human population.