Anesthetic management of a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) during laparotomy.
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.
Sasano
Nobuko
N
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.
Fujita
Yoshihito
Y
So
Minhye
M
Sobue
Kazuya
K
Sasano
Hiroshi
H
Katsuya
Hirotada
H
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
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