[Anesthetic management of a patient with mitochondrial encephalomyopathy for renal transplantation].

A 52-year-old man with mitochondorial encephalomyopathy was scheduled for renal transplantation from a living donor. He had some characteristic features including muscle weakness, deafness, cerebellar ataxia, diabetes meritus and renal failure. Anesthesia was induced with bolus infusion of propofol 1 mg x kg(-1) and continuous infusion of remifentanil at 0.15 microg x kg(-1) x min(-1) was started. After supporting ventilation for three minutes, the trachea was intubated without any muscle relaxant. Anesthesia was maintained with sevoflurane (0.4-1.0%), air and oxygen (33-50%) and with continuous infusion of 0.1-0.15 microg x kg(-1) x min(-1) of remifentanil without any muscle relaxant. The circulatory status was maintained with 1-5 microg x kg(-1) x min(-1) of dopamine depending on changes of CVP and BP. At the conclusion of the operation, respiratory depression lasted for about 25 minutes. After administration of naloxone 40 microg to antagonize the action of remifentanil, the patient recovered fully from the respiratory depression. The urine output was depressed initially after implantation of donor's kidney, but gradually increased to a usual recovery pattern. This case suggests that careful administration of remifentanil is mandatory in a patient with mitochondorial encephalomyopathy which enhances respiratory depression from opioids.