Dexmedetomidine as a non-triggering anesthetic agent in a patient with MELAS syndrome and systemic sepsis: A case report
10.17085/apm.2019.14.4.416
- Author:
Sang Hun KIM
1
;
Su Yeong PARK
;
Ki Tae JUNG
Author Information
1. Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea. mdmole@chosun.ac.kr
- Publication Type:Case Report
- Keywords:
Dexmedetomidine;
Intravenous anesthesia;
MELAS syndrome;
Remifentanil;
Sepsis
- MeSH:
Adult;
Anesthesia;
Anesthesia, Intravenous;
Anesthetics;
Colectomy;
Dexmedetomidine;
Hemodynamics;
Humans;
Malignant Hyperthermia;
MELAS Syndrome;
Propofol;
Sepsis;
Unconsciousness
- From:Anesthesia and Pain Medicine
2019;14(4):416-422
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The selection of anesthetic agents is important in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome patient because serious and unexpected complications can occur after anesthetic exposure.CASE: A 30-year-old man with MELAS syndrome and sepsis underwent colectomy. Propofol was administered by step-wise until target effect-site concentration (Ce) 1.0 µg/ml and stopped for the loss of consciousness and to avoid hemodynamic instability. After the loss of consciousness, total intravenous anesthesia (TIVA) using dexmedetomidine (1.0 µg/ml/h) and remifentanil (1–4 ng/ml of Ce) was performed for the maintenance of anesthesia to avoid malignant hyperthermia and mitochondrial dysfunction. During the surgery, the bispectral index score stayed between 26 and 44, and increased to 97 after the end of anesthesia.CONCLUSIONS: TIVA with dexmedetomidine and remifentanil as non-triggering anesthetic agents in patients with MELAS syndrome and systemic sepsis may have advantages to decrease damages associated with mitochondrial stress and metabolic burden.
