Perioperative management of anterior cervical spine fixation in a patient with hereditary angioedema: A case report

Hereditary angioedema (HAE) is a rare autosomal dominant disorder characterized by recurrent episodes of cutaneous or submucosal angioedema The condition usually accompanies a deficiency in the Cl esterase inhibitor (Cl-INH) that leads to the overproduction of bradykinin, causing an abrupt increase in vascular permeability. In the present case, a 44-year-old woman with a history of HAE was scheduled to undergo cervical anterior fusion surgery. We planned treatment with human Cl-inactivator concentrate (Berinert P) prior to surgery and examined her pharynx and larynx by using video laryngoscopy (McGRATH®MAC) before intubation but without abnormal findings. The operation was performed under total intravenous anesthesia, and no significant issue was observed during surgery. The patient was kept intubated postoperatively because of potential laryngeal edema attack and postoperative hemorrhage. On postoperative day 1, Berinert P and dexamethasone were additionally administrated. Then, we extubated the trachea safely after significant upper airway edema had been excluded by using flexible laryngoscopy. Careful observation and sufficient preparation for reintubation or urgent tracheotomy are needed for patients with HAE after general anesthesia We demonstrated that HAE could be managed without life-threatening airway compromise by employing adequate pharmacological interventions and sensible determination of the timing of extubatioa.