Mark Wefers Bettink

Chapter 2 26 Figure 1. Hits on mitochondria. Different hits on mitochondria which might be present for a patient. A long standing standard practice on the ward of liberally supplying oxygen to patients led to rise in mortality (32). Setting a more conservative goal for intensive care patients with a saturation between 94 and 98% decreased such negative effect of superfluous oxygen administration (33). Furthermore hyperoxia led to mitochondrial and cellular dysfunction (34). Mitochondria also adapt to hypoxia with a reduction of metabolism (35). Even return of cellular oxygenation after hypoxia induces cellular damage. Reperfusion after cardiac ischemia leads to mitochondrial damage and might be as damaging to cells as the ischemia alone (36). Medical treatment of diseases or secondary prevention may also lead to mitochondrial side effects. Indeed, in recent years new proof demonstrated the role of mitochondrial damage and/or dysfunction as central players in these side effects. Statins are a typical example of a widely-used drug causing mitochondrial side effects. The basis of preventing cardiovascular disease is lowering of LDL cholesterol, usually successfully achieved by prescribing such statins. However, 5-29 % of the patients stop the use of statins due to side effect of statin- induced muscle disease. Current evidence points to mitochondrial dysfunctionasanimportant factor,but theexactprocesshasnotbeenfullyunderstood(37). Many drugs used in the operating theater and in the ICU are also known for being able to induce mitochondrial alterations, for example propofol. During prolonged sedation a well-known side effect of this drug is the propofol-infusion syndrome; usually characterized by an unexplained high anion gap, metabolic acidosis, rhabdomyolysis and hyperkalemia. Propofol-infusion syndrome is a rare but serious complication, with a recent recommendation to check for mitochondrial disease if this complication develops (38-40). Other drugs commonly encountered in the ICU-setting that potentially cause mitochondrial side effects are antibiotics and chemotherapeutics. Serious side effects,