Anesthetic Management of a Patient with Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Symptoms (MELAS): A Case Report

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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Anesthetic management of laparoscopy-assisted total proctocolectomy in a cardiac sarcoidosis patient with a cardiac resynchronization therapy-defibrillator: a case report

JA Clinical Reports ◽

10.1186/s40981-020-00350-7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Yutaro Kammura ◽

Ai Fujita ◽

Yuji Karashima ◽

Shoko Nakayama ◽

Kazuhiro Shirozu ◽

...

Keyword(s):

Case Report ◽

Cardiac Resynchronization Therapy ◽

Cardiac Sarcoidosis ◽

Anesthetic Management ◽

Cardiac Resynchronization ◽

Total Proctocolectomy ◽

Sarcoidosis Patient ◽

Resynchronization Therapy

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Anesthetic management for cesarean delivery in a woman with congenital atlantoaxial dislocation and Chiari type I anomaly: a case report and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03751-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuyan Nie ◽

Weimin Zhou ◽

Shaoqiang Huang

Keyword(s):

Case Report ◽

Cesarean Delivery ◽

Anesthetic Management ◽

Neurological Complications ◽

Atlantoaxial Dislocation ◽

Epidural Needle ◽

Team Approach ◽

Anesthetic Techniques ◽

Type I ◽

Combined Spinal Epidural Anesthesia

Abstract Background The preferable choice of anesthesia for the patients with congenital atlantoaxial dislocation (CAAD) and type I Arnold Chiari malformations (ACM-I) has been a very confusing issue in clinical practice. We describe the successful administration of combined spinal-epidural anesthesia for a woman with CAAD and ACM-1 accompanied by syringomyelia. Case presentation Our case report presents the successful management of a challenging obstetric patient with CAAD and ACM-1 accompanied by syringomyelia. She had high risks of difficult airway and aspiration. The injection of bolus drugs through the spinal or epidural needle may worsen the previous neurological complications. The patient was well evaluated with a multidisciplinary technique before surgery and the anesthesia was provided by a skilled anesthesiologist with slow spinal injection. Conclusions An interdisciplinary team approach is needed to weigh risks and benefits for patients with CAAD and ACM-1 undergoing cesarean delivery. Therefore, an individual anesthetic plan should be made basing on the available anesthetic equipments and physicians’ clinical experience on anesthetic techniques.

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