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BJA Advance Access originally published online on February 19, 2008
British Journal of Anaesthesia 2008 100(4):436-441; doi:10.1093/bja/aen014
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 BJA: April 2008
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Mitochondrial disorders and general anaesthesia: a case series and review

E. J. Footitt1, M. D. Sinha1, J. A. J. Raiman1, A. Dhawan3, S. Moganasundram2 and M. P. Champion1,*

1 Department of Paediatric Metabolic Medicine
2 Department of Anaesthesia, Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK
3 Department of Paediatric Hepatology, King’s College Hospital, Denmark Hill, London SE5 9RS, UK

* Corresponding author. E-mail: michael.champion{at}gstt.nhs.uk

Patients with mitochondrial disease are at risk of metabolic decompensation and often require general anaesthesia (GA) as part of their diagnostic work up and subsequent management. However, the evidence base for the use of GA is limited and inconclusive. We have documented the practice and outcome in the use of GA in paediatric patients with mitochondrial disease using a retrospective case review study of 38 mitochondrial patients who had undergone 58 anaesthetics within the regional metabolic service for the period 1989–2005. A variety of anaesthetic agents were used and the pattern of use reflects that seen in standard paediatric practice. There were no episodes of malignant hyperthermia and no documented intraoperative events attributable to the GA. Three postoperative adverse events were noted; one episode of hypovolaemia, one episode of acute on chronic renal failure, and one episode of metabolic decompensation 12 h post-muscle biopsy. Despite theoretical concern about this group of patients, adverse events after GA are rare and in most cases unrelated to the anaesthesia. Further prospective studies of GA in mitochondrial disease are required to create evidence-based clinical guidelines for safe practice.

Keywords: anaesthesia, general; complications; metabolism, ATP; metabolism, lactate; surgery, paediatric


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Mitochondial disorders and Anaesthesia
Joshua Adedokun, et al.
British Journal of Anaesthesia, 23 Apr 2008 [Full text]

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