Management of Mitochondrial Disease — Mitochondrial Anesthesia Precautions — Clinical Pathway: Emergency Department and Inpatient

Mitochondrial Disease Clinical Pathway — Emergency Department and Inpatient

Mitochondrial Anesthesia Precautions

Many patients with mitochondrial disease can generally tolerate anesthesia, however some patients may have hypersensitivity to volatile anesthetics. Therefore, caution should be used on induction. General anesthesia recommendations for patients with mitochondrial disease are provided below.

Patients with mitochondrial disease are more sensitive to physiologic stressors such as minor illness, dehydration, fever, temperature extremes, surgery, anesthesia, and prolonged fasting/starvation. During such stress, rapid systemic decompensation may occur. Preventative measures are aimed at avoiding, or at least not exacerbating, such decompensation.

General Recommendations:

  • Avoid pre-operative fasting if possible. If fasting is necessary, limit the period to only overnight, or the shortest necessary interval.
  • Provide IV fluids with dextrose during prolonged pre-operative fasting.
  • IV fluids should not contain Lactated Ringer's solution unless the benefit outweighs the risk i.e. Concerns for shock or sepsis where LR may be the preferred fluid
  • Prolonged use of propofol (> 1 hour) should be avoided.
  • Schedule procedure(s) to be performed early in the day.

Additional information is available from expert clinicians that may assist in preparing the safest anesthetic plan for mitochondrial disease patients.

Reference

Hsieh VC, Krane EJ, Morgan PG Mitochondrial Disease and Anesthesia. Jnl of Inborn Errors of Metabolism and Screening This article lists specific anesthetic agents to consider or avoid to optimize care. 2017,