Perioperative anesthetic management of very long-chain acyl-coenzyme a dehydrogenase deficiency

Very long-chain acyl-coenzyme A dehydrogenase deficiency is a rare disorder of β-oxidation fatty acid metabolism that results in susceptibility to hypoglycemia, liver failure, cardiomyopathy and rhabdomyolysis during catabolic situations. We report the case of a 10-year-old male undergoing a totally implanted central venous catheter placement during hospitalisation for rhabdomyolysis, who was successfully managed with general anesthesia with nitrous oxide, sevoflurane and remifentanil. No hypoglycemia occurred and creatine kinase levels did not increase in the perioperative period. We describe the challenges encountered and the strategies used to avoid further decompensation of the disease due to surgical stress.

Disopyramide pharmacokinetics in the elderly after single oral administration

Disopyramide (D) kinetics were studied after single oral dose (200 mg) in ten elderly male patients (mean age: 75.5 yrs) without clinical or laboratory signs of hepatic, renal or cardiac disease, and in six healthy male subjects. They were all non smokers and had not taken alcohol for at least 10 days. Peak plasma concentration and area under the curve (AUCo-oo) were 54% and 51% respectively higher in the elderly group, whereas plasma half life was virtually the same in both groups (about 9 hrs). The major D metabolite, mono-N-desisopropyldisopyramide (MND), showed a tendency towards an increase of AUCo-24 h and T1/2 but did not reach the 5% significance level. Eight of the ten elderly patients but only two of the six young subjects complained of anticholinergic side effects. On the basis of the pharmacokinetic changes observed (and provided that plasma protein binding is unchanged), D oral dose should be reduced by 1/3, without modifying the dosage interval.