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Dexmedetomidine as a non-triggering anesthetic agent in a patient with MELAS syndrome and systemic sepsis - A case report -
Anesth Pain Med 2019;14(4):416-22
Published online October 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Sang Hun Kim , Su Yeong Park , and Ki Tae Jung
Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
Correspondence to: Ki Tae Jung, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Donggu, Gwangju 61453, Korea Tel: 82-62-220-3223 Fax: 82-62-223-2333 E-mail: mdmole@chosun.ac.kr
ORCID https://orcid.org/0000-0002-2486-9961
Received December 21, 2018; Revised March 8, 2019; Accepted March 14, 2019.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Key Words : Dexmedetomidine; Intravenous anesthesia; MELAS syndrome; Remifentanil; Sepsis.


October 2019, 14 (4)
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