Surgery considerations for mito

Introduction of Dr Christine Wools and topic overview

• Clare Stuart introduces Dr Christine Wools, a neurologist based in Melbourne, who has completed her PhD in mito.
• Dr Wools specialises in neurogenetics and practices in the care of patients with various neurogenetic disorders.
• The topic of the meeting is considerations related to surgery and mito.
• Dr Wools mentions the assistance of Dr Boris Tseitkin, an intensive care physician and perioperative physician, for answering specific questions.

Patient journey through surgery

• Dr Wools explains that surgery can occur quickly in emergencies or slowly for elective procedures.
• The journey includes attending a GP or emergency department, consulting specialists, and deciding whether surgery is necessary.
• The perioperative period involves fasting, anesthetic induction, surgery, and recovery.
• The typical day of surgery includes fasting to prevent vomiting during general anesthesia, which can be risky.

Considerations for patients with mitochondrial disease

• Dr Wools discusses the unique considerations for patients with mitochondrial disease during surgery.
• Mitochondrial dysfunction affects energy production and various body functions, including the respiratory chain and TCA cycle.
• Genetic changes can impact mitochondrial function, leading to energy deficiency.
• The perioperative period requires careful consideration of the patient’s specific health problems and medications.

Types of anesthesia and their implications

• Dr Wools explains different types of anesthesia, including general, sedation, regional, and local anesthetics.
• General anesthesia involves unconsciousness, while sedation is used for shorter procedures.
• Regional anesthesia, like epidurals, is considered for procedures where general anesthesia is highly risky.
• The anesthetist needs to know about the patient’s medical problems, particularly heart and lung function.

Impact of mitochondrial disease on anesthesia

• Dr Wools emphasises the importance of considering the patient’s metabolic function and specific health problems.
• General anesthetics can affect mitochondrial function, particularly the respiratory chain.
• Patients with severe respiratory or cardiac function issues may face higher risks under anesthesia.
• The anesthetist must carefully plan the anesthetic and consider the patient’s metabolic needs.

Management of metabolic challenges during surgery

• Dr Wools discusses the importance of managing glucose levels during surgery, especially for patients with diabetes.
• Prolonged fasting is avoided, and patients are typically put first on the surgery list to minimise fasting time.
• Intravenous fluids high in lactate are avoided, and nausea and vomiting are managed carefully.
• Post-operative recovery involves managing pain, nausea, hydration, nutrition, and bowel function.

Resources and recommendations

• Dr Wools mentions a patient resource on surgery considerations for patients with mitochondrial disease provided by the Mito Foundation.
• The resource offers more detailed information and is recommended for further reading.
• Other resources around the world are available, but the Mito Foundation’s resource is highly recommended.
• The importance of anticipating a potential setback in physical capacity post-surgery is emphasised.