Anesthetic considerations in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome: a case series

摘要: Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) is a rare inherited mitochondrial disorder associated with severe multiorgan pathology stress-induced of metabolic decompensation acidosis. The purpose this case series to review the medical records patients MELAS who underwent anesthetic care at Mayo Clinic observe their perioperative responses anesthesia assess outcomes. From September 1997 October 2010, nine were identified 20 general anesthetics, 12 prior diagnosis. Debilitating neurologic symptoms involved eight patients, three had substantial cardiac comorbidities. tolerated commonly used anesthetics muscle relaxants, including succinylcholine. Lactated Ringer’s solution was frequently. One patient noted have elevated postoperative serum lactate, but his lactate chronically elevated. Metabolic acidosis not observed in any patient. Hyponatremia hyperkalemia, sometimes profound, seven these abnormalities also occurred times remote from surgery. Two developed renal dysfunction following surgery abdominal for sepsis. hyponatremia hyperkalemia variable severity unrelated timing surgery, suggesting are prone major electrolyte disturbances. Given propensity develop acid-base disturbances lactacidemia, it prudent normalize adjust plan accordingly. Fortunately, limited data suggest that tolerate drugs well.