Anesthetic Hypersensitivity in a Case-Controlled Series of Patients With Mitochondrial Disease.
Anesthetic Hypersensitivity in a Case-Controlled Series of Patients With Mitochondrial Disease.
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DOI：
10.1213/ane.0000000000005430
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发表时间：
2021-10-01
影响因子：
5.7
通讯作者：
Morgan PG
中科院分区：
文献类型：
--
作者：
Hsieh VC;Niezgoda J;Sedensky MM;Hoppel CL;Morgan PG
Children with mitochondrial disease undergo anesthesia for a wide array of surgical procedures. However, multiple medications used for their peri-operative care can affect mitochondrial function. Defects in function of the mitochondrial electron transport chain (ETC) can lead to a profound hypersensitivity to sevoflurane in children. We studied the sensitivities to sevoflurane, during mask induction and maintenance of general anesthesia, in children presenting for muscle biopsies for diagnosis of mitochondrial disease. In this multi-center study, ninety-one children, ages 6 months-16 years, presented to the OR for diagnostic muscle biopsy for presumptive mitochondrial disease. General anesthesia was induced by a slow increase of inhaled sevoflurane concentration. The primary endpoint, end tidal sevoflurane necessary to achieve a Bispectral index (BIS) of 60, was recorded. Secondary endpoints were maximal sevoflurane used to maintain a BIS between 40–60 during the case, and maximum and minimum heart rate and blood pressures. After induction, general anesthesia was maintained according to the preferences of the providers directing the cases. Primary data was analyzed comparing data from patients with complex I deficiencies to other groups using nonparametric statistics in SPSS v.27. The median sevoflurane concentration to reach of BIS of 60 during inductions [End Tidal (ET) Sevoflurane % (BIS=60)] was significantly lower for patients with complex I defects (0.98%; 95%CI, 0.5–1.4) compared to complex II ((1.95% ; 95%CI, 1.2–2.7, p <.001)), complex III (2.0% ; 95%CI, 0.7–3.5 p <.001), complex IV ((2.0% ; 95%CI, 1.7–3.2; p <.001), and normal groups (2.2% ; 95%CI, 1.8–3.0, p <.001). The sevoflurane sensitivities of complex I patients did not reach significance when compared to patients diagnosed with mitochondrial disease but without an identifiable ETC abnormality (p=0.172). Correlation of complex I activity with ET Sevoflurane % (BIS=60) gave a Spearman’s coefficient of 0.505 (p<0.001). The differences in sensitivities between groups were less during the maintenance of the anesthetic than during induction. The data indicate that patients with complex I dysfunction are hypersensitive to sevoflurane compared to normal patients. Hypersensitivity was less common in patients presenting with other mitochondrial defects or without a mitochondrial diagnosis.
