Challenging anesthesia of the patient on ketogenic diet therapy scheduled for scoliosis surgery under motor evoked potentials monitoring: a case report

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Authors

HUDEC Jan KOSINOVÁ Martina HORÁK Ondřej REPKO Martin GÁL Roman

Year of publication 2023
Type Article in Periodical
Magazine / Source JOURNAL OF ANESTHESIA
MU Faculty or unit

Faculty of Medicine

Citation
Web https://link.springer.com/article/10.1007/s00540-023-03226-z
Doi http://dx.doi.org/10.1007/s00540-023-03226-z
Keywords Motor evoked potentials; Midazolam; Remifentanil; Total intravenous anesthesia; Case report
Attached files
Description Although propofol represents a “gold standard” from anesthetic drugs for total intravenous anesthesia (TIVA) with intraoperative neurophysiological monitoring (IONM), the anesthetic team should have an alternative plan in rare cases when the propofol is contraindicated, and remimazolam, a new ultra-short-acting benzodiazepine, is not available. We describe a patient suffering from glucose transporter type 1 deficiency syndrome (Glut1DS) with the history of epilepsy treated by ketogenic diet therapy (KDT) scheduled for scoliosis surgery under IONM. The prolonged propofol administration was contraindicated due to high doses of carbohydrates contained in propofol that may worsen epilepsy. In rare cases, prolonged propofol infusion can lead to propofol infusion syndrome (PRIS) in patients on KDT, and that is why anesthetic team has to prepare an alternative management to allow quality IONM.
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