Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.11.007
Brazilian Journal of Anesthesiology
Case Report

Anesthetic management of a patient with acquired angioedema submitted to broncofibroscopy: a case report

Manejo anestésico de paciente com angioedema adquirido submetido à broncofibroscopia: relato de caso

Melanie Barata, Ana Marques, Catarina Tiago, Marta Dias-Vaz, Nuno Losa, Carmen Oliveira

Downloads: 0
Views: 695

Abstract

Acquired angioedema with C1 inhibitor deficiency (AAE-C1INH) is a very rare condition of bradykinin-mediated angioedema. One of its major complications is potentially life-threatening, laryngeal edema. We report a 53-year-old woman with AAE-C1INH proposed for an elective broncofibroscopy. The direct stimulation caused by broncofibroscopy poses a high risk of angioedema, thus presenting an anesthetic challenge. Due to the risk of death, it is essential to adopt preventive measures. Short-term prophylaxis was performed, and the acute treatment was readily available. A well-structured multidisciplinary periprocedural plan makes it possible to safely approach the airway, in a remote area of the hospital.

Keywords

Angioedema;  C1 Esterase Inhibitor;  Airway Management;  Bronchoscopy

Resumo

O angioedema adquirido com deficiência de inibidor de C1 (AAE-C1INH) é uma condição muito rara de angioedema mediado por bradicinina. Uma de suas principais complicações é o edema laríngeo potencialmente fatal. Relatamos uma mulher de 53 anos com AAE-C1INH proposta para uma broncofibroscopia eletiva. A estimulação direta causada pela broncofibroscopia apresenta alto risco de angioedema, apresentando-se assim como um desafio anestésico. Devido ao risco de morte, é imprescindível a adoção de medidas preventivas. A profilaxia de curto prazo foi realizada e o tratamento agudo estava prontamente disponível. Um plano periprocedimento multidisciplinar bem estruturado possibilita a abordagem segura da via aérea, em uma área remota do hospital.

Palavras-chave

Angioedema; Inibidor C1 Esterase; Manejo das Vias Aéreas; Broncoscopia

References

1. Cicardi M, Aberer W, Banerji A, et al. Classification, diagnosis, and approach to treatment for angioedema: consensus report from the Hereditary Angioedema International Working Group. Allergy. 2014;69:602−16.

2. MacBeth LS, Volcheck GW, Sprung J, et al. Perioperative course in patients with hereditary or acquired angioedema. J Clin Anesth. 2016;34:385−91.

3. Hoyer C, Hill MR, Kaminski ER. Angio-oedema: an overview of differential diagnosis and clinical management. Continuing Education in Anaesthesia Critical Care & Pain. 2012;12:307−11.

4. Maurer M, Magerl M, Ansotegui I, et al. The international WAO/ EAACI guideline for the management of hereditary angioedema − the 2017 revision and update. Allergy. 2018;73:1575−96.

5. Bowen T, Cicardi M, Farkas H, et al. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol. 2010;6:24.

61b89b97a953952dc61e3ab4 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections