Gitelman syndrome with Arnold–Chiari malformation for neurosurgery

Abstract

The attempt to optimize potassium and magnesium levels and to correct metabolic alkalosis before surgery with intravenous Inj. potassium chloride and Inj. magnesium sulfate along with Tab. spironolactone did not yield any significant change in serum levels. [...]a nephrology consultation was asked for and a diagnosis of Gitelman syndrome was made. On the day of surgery, after attaching the standard monitors, that is, the five lead ECGs, noninvasive blood pressure monitoring, and pulse oximetry, the patient was induced with Inj. thiopentone sodium 5 mg/kg, Inj. fentanyl 4 μg/kg, and Inj. vecuronium 0.1 mg/kg, given to facilitate tracheal intubation. Anesthetic concerns included associated airway problems, electrolyte imbalance, increased sensitivity to neuromuscular blockers due to hypomagnesemia, preoperative ECG with QTc prolongation, risk of intraoperative arrhythmias, adverse cardiac events due to hypotension, and occult autonomic dysfunction associated with ACM.