Mitochondrial dysfunction can cause mitochondrial encephalomyopathy, which sometimes results in multiple organ failure. General anesthesia in patients with mitochondrial encephalomyopathy carries a risk of malignant hyperthermia and metabolic acidosis because of starvation arising from the necessary restriction of oral intake before surgery. We report a case of day-care general anesthesia in a patient with mitochondrial encephalomyopathy combined with hypercreatinekinasemia who underwent dental treatment.
The patient was a 17-year-old woman with a body weight of 50 kg and a height of 140 cm. The patient was diagnosed as having cytochrome C oxidase partial deficiency-type mitochondrial encephalomyopathy. Since she was uncooperative with the dental treatment, we planned to perform general anesthesia.
Water intake was restricted for 2 hours before the induction of anesthesia. Anesthesia was induced using oxygen, midazolam, propofol, and remifentanil. Rocuronium was injected under train of four monitoring. The anesthesia was maintained using total intravenous anesthesia under controlled ventilation. We adjusted the infusion rate of propofol and remifentanil while referring to the bispectral index values. For the transfusion, Ringer’s acetate solution with 1.8% glucose was used. The patient’s respiratory and hemodynamic variables were stable, and an arterial blood gas analysis remained at normal levels throughout the anesthesia. At the end of the treatment, sugammadex was administered, and the patient was extubated. No complications were observed after the anesthesia.
