title: Anesthetic Management of Mitochondrial Encephalopathy With Lactic Acidosis and Stroke-Like Episodes (MELAS Syndrome) in a High-Risk Pregnancy: A Case Report.
abstract: MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like symptoms) is a rare and complex mitochondrial disorder. We present the in-hospital course of a 36-year-old gravida 2, para 0 with MELAS syndrome and severe preeclampsia, complicated by hyponatremia, hyperkalemia, and diabetes. A retained placenta with postpartum hemorrhage required urgent instrumental delivery under spinal anesthesia, transfusion, and intensive care unit admission for pulmonary edema, effusions, and atelectasis. Postpartum endometritis and sepsis also were encountered. This is to our knowledge the first case report of obstetric complications in MELAS syndrome and highlights the salient metabolic sequelae of this syndrome.
authors.affiliation: From the *Department of Anesthesiology, University of Toronto; and †Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Josh D
authors.initials: JD
authors.lastname: Bell
authors.forename: Kushlin
authors.initials: K
authors.lastname: Higgie
authors.forename: Mital
authors.initials: M
authors.lastname: Joshi
authors.forename: Joshua
authors.initials: J
authors.lastname: Rucker
authors.forename: Sahar
authors.initials: S
authors.lastname: Farzi
authors.forename: Naveed
authors.initials: N
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D017241:MELAS Syndrome / Q000150:complications*; D011225:Pre-Eclampsia; D011247:Pregnancy; D011248:Pregnancy Complications