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J Pediatr Genet 2021; 10(01): 053-056
DOI: 10.1055/s-0040-1702153
Case Report

Endotracheal Intubation Using Alfentanil in a Pediatric Patient with a Mitochondrial Myopathy and Gastroparesis

Sonia D. Mehta
1   Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, United States
,
Wendy L. Leavitt
1   Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, United States
,
Gijo Alex
2   Division of Pediatric Anesthesiology, Department of Anesthesiology, UT Southwestern Medical Center, Dallas, Texas, United States
,
Rita Saynhalath
2   Division of Pediatric Anesthesiology, Department of Anesthesiology, UT Southwestern Medical Center, Dallas, Texas, United States
,
Edgar Kiss
2   Division of Pediatric Anesthesiology, Department of Anesthesiology, UT Southwestern Medical Center, Dallas, Texas, United States
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Abstract

Children with mitochondrial disorders represent a subset of patients who require unique anesthetic considerations. Routinely administered medications for general anesthesia, such as propofol, have been shown to increase the risk of developing metabolic acidosis. In addition, both depolarizing and nondepolarizing neuromuscular blockers are contraindicated due to the risk of hyperkalemic cardiac arrest and worsening of preexisting muscle weakness, respectively. These limitations pose challenges while choosing appropriate medications for induction of general anesthesia, especially when the risk of aspiration is high. We present a novel case of using inhaled sevoflurane and intravenous alfentanil to facilitate intubation in a 4-year-old girl with a complex 1 mitochondrial disorder suffering from severe gastroparesis and esophageal dysmotility.

Keywords

alfentanil - general anesthesia - mitochondrial disease


Publication History

Received: 14 November 2019

Accepted: 15 January 2020

Article published online:
17 February 2020

© 2020. Thieme. All rights reserved.

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