Anesthetic management of late pressure angioedema

• Main Authors: Inês Furtado, Filipe Linda, Sílvia Pica, Marco Monteiro
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Anestesiologia
• Series: Revista Brasileira de Anestesiologia
• Subjects: Angioedema; Pressure; Airway
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000400422&lng=en&tlng=en

Abstract Background and objectives: Late pressure angioedema is a rare form of angioedema in which light pressure stimulus can lead to edema after 1-12 h. This uncommon and unreported entity is especially important in patients who undergo general anesthesia, for whom the usual harmless supine position, intravenous catheter insertion, standard monitoring, airway management and ventilation can lead to life threatening consequences as the trigger is a physical stimulus. Case report: In this report, we describe a successful perioperative anesthetic management of a 30 year old patient, proposed for intra-ocular lens insertion, with a severe form of the disease with peri-oral, tongue and limb edema presentation. Conclusion: Due to lack of quality evidence, our conduct was based on the pathophysiology mechanisms of the syndrome, histamine and pro-inflammatory cytokines release, with special focus on a careful peri-operative assessment and prophylaxis, minimization of all the possible pressure stimulus, especially in the airway structures, and a strict post-operative monitoring.