Anaesthetic Approach for Patient with Hereditary Angioedema [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-90522 | DOI: 10.5152/TJAR.2019.90522  

Anaesthetic Approach for Patient with Hereditary Angioedema

Maize Cordeiro Melo, Walkiria Wingester Vilas Boas, Marcos Daniel Faria, Alyne Andrade Lima, Rafaela Souto Souza
Hospital of the Clinics of the Federal University of Minas Gerais, Belo Horizonte, Brazil

Hereditary Angioedema (HEA), a disease caused by a mutation in the gene that encodes for the production of the fraction C1 in the complement (C1-INH), is a rare pathology (1/50.000) that causes swelling of the skin and submucosa in various organs, either naturally triggered or provoked by physical and psychological traumas, infections, or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme inhibitors (ACEIs). Surgical trauma may spur the HEA crisis, leading to complications such as the swelling of the respiratory tracts and hemodynamic instability. Thus, the pre-surgical approach to HEA patients requires a specific plan that ensures short term prophylaxis, careful intra-operative management, rescue therapy and intensive post-surgery care. We present a report on a video-laparoscopic cholecystectomy approach for a 28-year-old woman diagnosed with asthma and HEA with symptomatic choledocholithiasis. We opted for short-term prophylaxis and immunology with the intravenous application of C1-INH. Ultrasonography imaging showed arterial wall oedema, which could correspond to a manifestation of C1-INH deficiency in the wall of the manipulated arteries during ultrasonography-guided puncture. Once the patient recovered consciousness, she was transferred to the intensive care unit and was discharged on the 6th day of hospitalisation.

Keywords: Anaesthesia, C1 complement inhibitory protein, hereditary angioedema

Corresponding Author: Maize Cordeiro Melo, Brazil

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