Features of anesthesia in a child with pyruvate kinase deficiency in an outpatient dental clinic: case report

INTRODUCTION: Pyruvate kinase deficiency is the most common enzymatic disorder of the glycolytic pathway and a leading cause of hereditary nonspherocytic hemolytic anemia. Anesthetic management in patients with pyruvate kinase deficiency carries a risk of specific complications related to impaired energy metabolism and increased susceptibility of erythrocytes and muscle cells to oxidative stress. OBJECTIVE: To present a clinical case demonstrating the successful use of combined inhalational anesthesia in outpatient pediatric dental practice in a child with pyruvate kinase deficiency. MATERIALS AND METHODS: We describe the anesthetic management and specific considerations in the administration of combined inhalational anesthesia during comprehensive dental treatment in a pediatric patient with confirmed pyruvate kinase deficiency. RESULTS: This approach provided adequate anesthesia throughout the dental procedure without the need for intravenous induction with propofol or administration of muscle relaxants, thus minimizing the risk of oxidative stress and mitochondrial dysfunction. CONCLUSIONS: Anesthetic management in patients with pyruvate kinase deficiency should be individualized, with emphasis on minimizing oxidative injury, maintaining adequate oxygen-carrying capacity, and preventing systemic metabolic complications. Inhalational techniques may offer a safe and effective alternative in selected cases.