Perioperative considerations of pyruvate dehydrogenase complex deficiency: a case report of two consecutive anesthesia

Pyruvate dehydrogenase complex (PDHC) deficiency is a rare mitochondrial disorder caused by a genetic mutation affecting the activity of the PDHC enzyme, which plays a major role in the tricarboxylic cycle. Few cases of surgery or anesthesia have been reported. Moreover, there is no recommended anes...

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Bibliographic Details
Published in:Anesthesia and pain medicine (Korean society of anesthesiologists) 2023-07, Vol.18 (3), p.270-274
Main Authors: Lim, Won Yong, Lee, Hyeon-Jeong, Park, Eun Ji, Jeon, Soeun, Do, Wangseok, Kim, Hyae Jin, Lee, Dowon, Hong, Jeong-Min
Format: Article
Language:English
Subjects:
acid-base imbalance
anesthesia, inhalation
lactic acidosis
mitochondrial disease
Pediatric Anesthesia
pyruvate dehydrogenase complex deficiency disease
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Summary:Pyruvate dehydrogenase complex (PDHC) deficiency is a rare mitochondrial disorder caused by a genetic mutation affecting the activity of the PDHC enzyme, which plays a major role in the tricarboxylic cycle. Few cases of surgery or anesthesia have been reported. Moreover, there is no recommended anesthetic method. A 24-month-old child with a PDHC deficiency presented to the emergency room with respiratory failure, mental decline, systemic cyanosis, and lactic acidosis. During hospitalization period, the patient presented with pneumothorax, pneumoperitoneum, and multiple air pockets in the heart. Two surgeries were performed under general anesthesia using an inhalational anesthetic agent. The patient was discharged with home ventilation. Anesthesiologists should be wary of multiple factors when administering anesthesia to patients with PDHC deficiency, including airway abnormalities, acid-base imbalance, intraoperative fluid management, selection of appropriate anesthetics, and monitoring of lactic acid levels.
ISSN:1975-5171
2383-7977
DOI:10.17085/apm.23034