Progressive mitochrondrial disease for SPC

68yo lady with progressive mitochondrial disease with neuropathic bladder, for botox injections, cystoscopy and SPC.


  • Progressive mitochondrial disease
    • Looked after through mitochondrial dx clinic at RNSH
    • Mostly wheelchair bound
    • Nil known CVS/RS complications
    • Spirometry in clinic somewhat reassuring, values >50%
    • Not a variant strongly associated with refractory seizures
    • Nil reported dysphagia
    • Known to palliative care
  • HTN
  • Depression


  • Anaesthetic technique?
    • Above guidelines suggest:
      • Greatest perioperative risks derive from the severity of the patient’s pre-existing CVS/RS/CNS dx components
      • No specific anaesthetic technique or drug contraindicated
      • Not associated with MH
      • Chronic bowel dilatation and GI dysmotility puts these patients at risk of severe complications post-op due to opioids. Techniques to minimize opioids are ideal and prescribed bowel care necessary.
      • Baseline CK and lactate levels help to stratify severity of disease and to identify dynamic changes postop.
      • Increased VTE risk due to immobility


  • Proceed with surgery
  • Preop TTE as arranged by clinic
  • Group consensus was that a short acting SAB would be ideal (? Prilocaine) 
  • Procedural anaesthetist notified.