Alkaptonuric ochronosis, caused by a deficiency of
homogentisate 1,2-dioxygenase, is a rare, autosomal recessive, metabolic disorder. Accumulation of homogentisate
acid (HGA) at the connective tissue destructs the spine and large joints, and cardiac valvular disease is prominent. In this report, we describe a case of
alkaptonuric ochronosis for
anesthetic management. A 75-year-old female patient with the disease was scheduled for a
total-hip arthroplasty. We avoided applying
general anesthesia for her valvular regurgitations.
Spinal anesthesia was achieved successfully, and resulted in a
hypesthesia level at T12. Although a epidural
catheter was indwelled with no leak of cerebrospinal fluid, an accidental dural
puncture appeared later during the surgery, suggesting a subdural catheterization. She had an uneventful perioperative course without any symptoms. In the patient of
alkaptonuric ochronosis, the dura and arachnoid membrane could be damaged made vulnerable by HGA. In addition, since the clinical findings resemble
ankylosing spondylitis, degenerative changes such as a narrowing of the disk space and spine fusion would make the regional technique unsuccessful. In term of
anesthesia,
alkaptonuric ochronosis requires ingenuity since there are a number of factors associated with prevention of untoward complications. Each case is to be evaluated individually and managed carefully.