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Affiliation(s)
- Kyeong Seon M Kim
- UC Davis Department of Anesthesiology and Pain Medicine, UC Davis Medical Center, PSSB Suite 1200, Sacramento, CA 95817, USA
| | - Robert Scott Kriss
- UC Davis Department of Anesthesiology and Pain Medicine, UC Davis Medical Center, PSSB Suite 1200, Sacramento, CA 95817, USA
| | - Timothy J Tautz
- UC Davis Department of Anesthesiology and Pain Medicine, UC Davis Medical Center, PSSB Suite 1200, Sacramento, CA 95817, USA.
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Lilitsis E, Astyrakaki E, Blevrakis E, Xenaki S, Chalkiadakis G, Chrysos E. Anesthetic management of a pediatric patient with Electron Transfer Flavoprotein Dehydrogenase deficiency (ETFDH) and acute appendicitis: case report and review of the literature. BMC Anesthesiol 2017; 17:116. [PMID: 28851284 PMCID: PMC5576333 DOI: 10.1186/s12871-017-0400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitochondria are the energy producing organelles practically in every human cell except erythrocytes. Indeed mitochondria are widespread in high energy requiring organs like brain, heart and muscles. Currently there are no clinical trials supporting with clear evidence which is the most suitable surgical or anesthetic management of a patient with known mitochondrial disease presenting with surgical disorders. This condition poses possible hazardous problems to the medical attention of those patients. CASE PRESENTATION A case of an 8 year old child with known Electron Transfer Flavoprotein Dehydrogenase deficiency (ETFDH deficiency) requiring surgery for acute appendicitis is presented. Our approach for anesthesia revealed a combination of fentanyl, low dose propofol and nitrous oxide. CONCLUSION The choice of the safest pharmacological anesthetic agents for patients with ETFDH deficiency is challenging given that most of the general anesthetic medications have multiple effects on mitochondria, fatty acids metabolism and striated muscles. Anesthetists are expected to individualize anesthetic care for the patient based on current publications for similar cases, medical history and knowledge of pharmacology and physiology.
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Affiliation(s)
- Emmanuel Lilitsis
- Department of Anesthesiology, University Hospital of Crete, Herakllion, Greece
| | - Elisavet Astyrakaki
- Department of Anesthesiology, University Hospital of Crete, Herakllion, Greece
| | - Evaggelos Blevrakis
- Department of Pediatric Surgery, University Hospital of Crete, 71110, Herakllion, Greece
| | - Sofia Xenaki
- Department of Pediatric Surgery, University Hospital of Crete, 71110, Herakllion, Greece
| | - George Chalkiadakis
- Department of Pediatric Surgery, University Hospital of Crete, 71110, Herakllion, Greece
| | - Emmanuel Chrysos
- Department of Pediatric Surgery, University Hospital of Crete, 71110, Herakllion, Greece.
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Anaesthesia and orphan disease: a patient with spinal muscular atrophy type III (Wohlfart-Kugelberg-Welander syndrome) undergoing laparoscopic cholecystectomy. Eur J Anaesthesiol 2014; 32:211-3. [PMID: 25159053 DOI: 10.1097/eja.0000000000000145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sharma A, Agrawal N, Batra R. Anaesthetic management of a case of distal myopathy. Indian J Anaesth 2014; 58:228-30. [PMID: 24963203 PMCID: PMC4050955 DOI: 10.4103/0019-5049.130853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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López Álvarez A, Román Fernández A, Vilanova Vázquez V, Corujeira Rivera MC, Areán González I, Valiño Hortas C. Total intravenous anesthesia for aortic aneurysm replacement surgery in a patient with limb-girdle dystrophy. ACTA ACUST UNITED AC 2013; 61:385-7. [PMID: 24035539 DOI: 10.1016/j.redar.2013.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/19/2013] [Accepted: 06/21/2013] [Indexed: 11/19/2022]
Abstract
We report the anesthetic management with total intravenous anesthesia of a 61-year-old male diagnosed with limb-girdle muscular dystrophy admitted for replacement of ascending aorta due to an aortic aneurysm. Limb-girdle muscular dystrophy belongs to a genetically heterogeneous group of muscular dystrophies involving shoulder and hip girdles. Although the risk of malignant hyperthermia does not seem to be increased in these patients compared with the general population, the exposure to inhaled anesthetics and succinylcholine should probably be avoided because these patients have a predisposition to hyperkalemia and rhabdomyolysis. We chose to use total intravenous anesthesia with propofol, remifentanil and muscle relaxants to reduce oxygen consumption, and later to reduce the doses of propofol and remifentanil. The combination of a carefully planned anesthetic strategy, anesthetic depth, and neuromuscular blockade monitoring is explained.
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Affiliation(s)
- A López Álvarez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain.
| | - A Román Fernández
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
| | - V Vilanova Vázquez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
| | - M C Corujeira Rivera
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
| | - I Areán González
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
| | - C Valiño Hortas
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
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Stewart PA, Phillips S, De Boer HD. Sugammadex reversal of rocuronium-induced neuromuscular blockade in two types of neuromuscular disorders: Myotonic dystrophy and spinal muscular atrophy. ACTA ACUST UNITED AC 2012; 60:226-9. [PMID: 22947194 DOI: 10.1016/j.redar.2012.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/06/2012] [Indexed: 10/27/2022]
Abstract
Neuromuscular disorders like myotonic dystrophy (dystrophia myotonica or Steinert's disease) and spinal muscular atrophy are associated with perioperative complications related to muscle weakness. These patients have an increased sensitivity to non-depolarising neuromuscular blocking agents, which can lead to postoperative residual curarization (PORC) and its associated respiratory complications. Adequate reversal of neuromuscular blockade is essential to prevent this. Sugammadex is the first selective relaxant binding agent and it reverses rocuronium- and vecuronium-induced neuromuscular block. Two cases are reported in which the patients received sugammadex to reverse a rocuronium-induced neuromuscular block. Reversal of the rocuronium-induced neuromuscular block (NMB) in both cases was fast, effective and without recurarization, and no safety concerns were observed.
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Affiliation(s)
- P A Stewart
- Department of Anesthesia, Sydney Adventist Hospital, Wahroonga, NSW, Australia
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Lerman J. Perioperative management of the paediatric patient with coexisting neuromuscular disease. Br J Anaesth 2012; 107 Suppl 1:i79-89. [PMID: 22156273 DOI: 10.1093/bja/aer335] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Children with neuromuscular diseases present a wide range of clinical manifestations and clinical implications for the anaesthesiologist. Neuromuscular diseases in children affect muscle strength by either directly weakening the muscle fibrils or indirectly by a degenerative nerve supply and weak neuromuscular junction. Of the more than 200 neuromuscular disorders known, the vast majority are genetic in origin. This review focuses on four of the more common neuromuscular disorders with emphasis on their pathophysiology and clinical implications for anaesthesiologists: malignant hyperthermia, the muscular dystrophies (Duchenne's, Becker's, and Emery-Dreifuss), mitochondrial disorders, and cerebral palsy.
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Affiliation(s)
- J Lerman
- Department of Anaesthesia, Women and Children's Hospital of Buffalo, State University of New York at Buffalo, 219 Bryant St, Buffalo, NY 14222, USA.
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Marsh S, Ross N, Pittard A. Neuromuscular disorders and anaesthesia. Part 1: generic anaesthetic management. ACTA ACUST UNITED AC 2011. [DOI: 10.1093/bjaceaccp/mkr020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Anaesthesia in children with inherited neuromuscular diseases. SRP ARK CELOK LEK 2010; 138:768-76. [DOI: 10.2298/sarh1012768s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Children with inherited neuromuscular diseases often require anaesthesia for
diagnostic or therapy procedures. These patients have an increased risk of
perioperative complications due to the nature of the disease and medications
administered during anaesthesia. Many anaesthetics and muscle relaxants can
aggravate the underlying disease and trigger life-threatening reactions
(cardiorespiratory complications, malignant hyperthermia). Besides, the
neuromuscular disorders are associated with atypical and undesirable
responses to drugs used during anaesthesia and the perioperative period. The
paper presents pathophysiological basis of inherited/genetic neuromuscular
diseases and specific anaesthesiological problems. The recommendations are
suggested with the aim to make the perioperative course in children optimally
safe.
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Neuromuscular and mitochondrial disorders: what is relevant to the anaesthesiologist? Curr Opin Anaesthesiol 2008; 21:350-5. [PMID: 18458553 DOI: 10.1097/aco.0b013e3282f82bcc] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW The review provides an up-to-date information to the anaesthesiologist about the more frequent and important neuromuscular disorders for which new basic insights or clinical implications have been reported. RECENT FINDINGS The findings include the mechanisms of the hyperkalemia after succinylcholine in patients with upregulation of acetylcholine receptors. New insights into the mechanism of malignant hyperthermia-like reactions such as rhabdomyolysis during anaesthesia in patients with Duchenne muscular dystrophy have been published. The importance of mitochondrial defects and the effect of agents used in anaesthesia on mitochondrial function are also highlighted. SUMMARY The increased understanding of the genetics and pathophysiology of common muscle disorders may lead to a decrease in life-threatening complications related to surgery and anaesthesia. However, there is still a lack of prospective clinical studies to determine which is the safest anaesthetic technique for these patients.
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Successful management of malignant hyperthermia during orthognathic surgery: a case report. J Oral Maxillofac Surg 2008; 66:1485-8. [PMID: 18571035 DOI: 10.1016/j.joms.2007.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 05/16/2007] [Accepted: 09/05/2007] [Indexed: 11/22/2022]
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Evron S, Glezerman M, Harow E, Sadan O, Ezri T. Human Immunodeficiency Virus: Anesthetic and Obstetric Considerations. Anesth Analg 2004; 98:503-511. [PMID: 14742395 DOI: 10.1213/01.ane.0000097193.91244.50] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold of its third decade of existence. The World Health Organization-United Nations statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to get much worse. Women of reproductive age are the fastest growing population with HIV. Common signs and symptoms have become more moderate or subclinical, and new clinical presentations have emerged. It is quite apparent that HIV-disease affects multiple organ systems. Advances have been made in elucidating the pathogenesis of HIV. In addition, the molecular technique of viral load determination and the CD + 4 T-lymphocyte count enable evaluation of the disease, its prognosis, and its response to therapy. There is limited specific information concerning the overall risk of anesthesia and surgery of HIV/AIDS patients. However, as far as can be determined, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of pregnancy complications or that pregnancy may alter the course of HIV infection. General anesthesia is considered safe, but drug interactions and their impact on various organ systems should be considered preoperatively. Regional anesthesia is often the technique of choice. Yet, one must take into consideration the presence of neuropathies, local infection, or blood clotting abnormalities. It should be emphasized that all practicing anesthesiologists should be familiar with the disease and should use prenatal anesthesia consultations and a team approach to assure optimal treatment for HIV patients.
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Affiliation(s)
- Shmuel Evron
- *Obstetric Anesthesia Unit, the †Department of Obstetrics and Gynecology, the ‡Ambulatory Surgical Unit, §Delivery Ward, ∥Department of Anesthesia, The Edith Wolfson Medical Center, Holon (Israel), Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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