Neuraxial anesthesia for extended endoscopic urological procedure in a patient with MELAS syndrome: a case report

We present a case of a 36-years-old male patient with MELAS syndrome (Mitochondria) myopathy, Encephalopathy, Lactic acidosis, and Stroke-like episodes) underwent ureteroscopy, lithotripsy and indwelling double) stent exchange under neuraxial anesthesia. MELAS is a progressive mitochondrial myopathy that results in defects in respiratory enzyme complexes I and IV, which lead to defects in aerobic metabolism, thus endangering high-energy-dependent organs. MELAS causes a wide range of physiologic changes that present a variety of challenges to the anesthetists. In this case, we managed our patient safely with spinal/epidural anesthesia without any major complications.