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. Author manuscript; available in PMC: 2020 Sep 1.
Published in final edited form as: Curr Anesthesiol Rep. 2019 Jul 12;9(3):340–359. doi: 10.1007/s40140-019-00345-w

Table 3.

Perioperative anesthetic management of PA and MMA

PREOP INTRAOP POSTOP

  • Consider hospital admission

  • Evaluate: nutritional status, neurologic status, muscle tone, GI function, renal status, CV status

  • D10 fluids while NPO

  • Labs: glucose, ammonia, pH, CBC, electrolytes

  • l-Carnitine

  • Metronidazole

  • Bicarbonate

  • Vitamin B12 for MMA

  • Consider RSI

  • Avoid/caution: propofol, LR fluid, certain NMBs, N2O for MMA

  • Maintain hemodynamic stability, normothermia

  • Consider regional anesthesia

  • D10 fluids

  • Labs: glucose, ammonia, acid-base, electrolytes

  • l-Carnitine

  • Metronidazole

  • Bicarbonate

  • Monitor for respiratory depression, airway obstruction, metabolic crises

  • Prevent PONV

  • Adequate pain control

  • Avoid ibuprofen, naproxen, LR

  • Restart low-protein diet ASAP

  • D10 fluids while NPO

  • Labs: glucose, ammonia, pH, electrolytes

  • l-Carnitine

  • Metronidazole

  • Bicarbonate

  • Vitamin B12 for MMA