title: Anesthetic management of a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) during laparotomy.
abstract: A 53-year-old man with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) underwent a gastrectomy. We administered bicarbonated Ringer's solution, which has a physiological concentration of bicarbonate. The level of serum lactate did not increase significantly, and metabolic acidosis did not occur throughout surgery or for 3 h after surgery. Aggressive warming was needed to maintain normothermia, presumably because the mitochondrial respiratory chain, which is responsible for thermogenesis, is impaired in MELAS patients. It is important to maintain normothermia in MELAS patients in order to avoid further mitochondrial metabolic depression.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8622, Japan.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Sasano
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Fujita
authors.forename: Minhye
authors.initials: M
authors.lastname: So
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.forename: Hirotada
authors.initials: H
authors.lastname: Katsuya
mesh_terms: D000577:Amides / Q000008:administration & dosage; D000758:Anesthesia / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001784:Blood Gas Analysis / Q000379:methods; D001831:Body Temperature / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D005283:Fentanyl / Q000008:administration & dosage; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007552:Isotonic Solutions / Q000008:administration & dosage; D019344:Lactic Acid / Q000097:blood; D008012:Lidocaine / Q000008:administration & dosage; D017241:MELAS Syndrome / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D000077212:Ropivacaine; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D014673:Vecuronium Bromide / Q000008:administration & dosage
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D007552:Isotonic Solutions; D003473:Neuromuscular Nondepolarizing Agents; C506920:bicarbonated Ringer's solution; D019344:Lactic Acid; D014673:Vecuronium Bromide; D000077212:Ropivacaine; D008012:Lidocaine; D005283:Fentanyl; D015742:Propofol