Multimodal Anesthesia for Glaucoma Surgery in a Child with Mitochondrial Disease and Malignant Hyperthermia

Mitochondrial disorders (MD) are a heterogeneous group of genetic disorders that impair mitochondrial integrity and result in deficient energy production. The disorder has an incidence of 1:5000 live births [1], and affects tissues with high-energy requirements such as the central nervous system, retina, heart and muscle [2]. Consequently, these patients have multiple comorbidities that include cardiac, endocrine, and neurologic dysfunction [3-5]. Current evidence suggests that mitochondrial disease may be a contributing factor in the pathogenesis of glaucoma [6]. Anesthesia in this patient population may prove hazardous because the stress of surgery and fasting can induce marked metabolic aberrations, most commonly lactic acidosis [7].