Hemodynamic collapse and severe metabolic acidosis following propofol in the setting of undiagnosed mitochondrial dysfunction: a case report

Abstract

Anesthetic management of patients with mitochondrial disorders is challenging due to their rare nature, and difficulties to develop evidence–based protocols for general anesthesia. We report a case of a 52–year–old male with hypertension, congenital deafness, optic neuritis, hypogonadism and myotonia, who developed severe refractory hypotension and bradycardia, and intractable severe lactic acidosis during induction of general anesthesia with fentanyl, propofol, and succinylcholine. The surgery had to be postponed and supportive management started. After extensive work–up, the patient was diagnosed with probable mitochondrial dysfunction. Patient returned for surgery under a different anesthetic regimen consisting of ketamine, fentanyl, ephedrine and dexmedetomidine; yielding a successful perioperative course and highlighting potential alternative strategies to manage anesthesia in patients with such disorders.

Key words: Mitochondrial Diseases; Propofol Infusion Syndrome; Lactic Acidosis

Abbreviations: MD – Mitochondrial disorders; PRIS – Propofol related infusion syndrome; HIPAA – Health Insurance Portability Accountability Act; MAP Mean arterial pressure; NMBAs – Neuromuscular blocking agents.

Citation: Kim DW, Hu A, Vaughn D, Rajan GRE. Hemodynamic collapse and severe metabolic acidosis following propofol in the setting of undiagnosed mitochondrial dysfunction: a case report. Anaesth. pain intensive care 2021;25(4):527–531. DOI: 10.35975/apic.v25i4.1587

Received: September 24, 2020. Reviewed: April 1, 2021, Accepted:  May 31, 2021