Anesthesia for Urgent Surgery in a Patient with Angioneurotic Oedema: A Case Report
Said Khallikane *
Service de Réanimation Chirurgicale, Hôpital Militaire d’Instruction Mohammed V (HMIMV) de Rabat, Royaume du Maroc, Morocco.
Aziz Benakrout
Bloc Opératoire Central, Hôpital Militaire d’Instruction Mohammed V (HMIMV) de Rabat, Royaume du Maroc, Morocco.
Hanane Delsa
Service de Gastro-Entérologie et de Proctologie, Université Mohammed VI des Sciences de la Santé (UM6SS), Hôpital Internaional Cheikh Khalifa Bin Zayd Al Nahyan, Casablanca, Royaume du Maroc, Morocco.
Mohamed Moutaoukil
Bloc Opératoire Central, Hôpital Militaire d’Instruction Mohammed V (HMIMV) de Rabat, Royaume du Maroc, Morocco.
Khalil Abou Elalaa
Bloc Opératoire Central, Hôpital Militaire d’Instruction Mohammed V (HMIMV), Faculté de Médecine et de Pharmacie de Rabat, Royaume du Maroc, Morocco.
Samir Siah
Service de Réanimation pour Grands Brûlés, Hôpital militaire d’instruction Mohammed V (HMIMV), Faculté de Médecine et de Pharmacie de Rabat, Royaume du Maroc, Morocco.
Hicham Balkhi
Service de Réanimation Chirurgicale, Hôpital Militaire d’Instruction Mohammed V (HMIMV), Faculté de Médecine et de Pharmacie de Rabat, Morocco.
Abdelouahed Baite
Département d’Anesthésie Réanimation, Hôpital Militaire d’Instruction Mohammed V (HMIMV), Faculté de Médecine et de Pharmacie de Rabat, Royaume du Maroc, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Hereditary angioneurotic oedema is an autosomal dominant disease associated with serum deficiency of functional C1-inhibitor. It is characterized by periodic swelling of subcutaneous tissues, abdominal viscera and upper airways. Lethal acute episodes of oedema can occur during anaesthesia and surgery. It is essential to prepare such patients before surgery. This article describes a case and the various preventive measures used to avoid acute episodes during anaesthesia for urgent surgery for mesenteric ischemia. In emergency situations where C1 inhibitor concentrate is not available, fresh frozen plasma (FFP) can be used as an alternative, as it also contains C1 inhibitor, corticosteroids, antihistamines, and epinephrine can be useful adjuncts but typically are not efficacious in aborting acute attacks. Prophylactic management involves long-term use of attenuated androgens or antifibrinolytic agents (Tranexamic acid).Their various indications are discussed.
Keywords: Angioneurotic oedema, c1-inhibitor deficiency, prevention, complication.