Perioperative course in patients with hereditary or acquired angioedema.
OBJECTIVE
Two types of bradykinin-mediated angioedema, hereditary angioedema (HAE) and acquired angioedema (AAE), result from deficiency or dysfunction of C1 esterase inhibitor, leading to an overproduction of bradykinin, which can lead to vascular permeability and life-threatening angioedema of the airway. The objective of this study was to review perioperative outcomes in a series of patients with HAE and AAE and to review current knowledge about anesthetic complications in patients with HAE or AAE.


METHODS
Medical records were retrospectively reviewed for perioperative complications in patients with HAE or AAE who underwent general anesthesia from January 1, 2000, to December 31, 2014, at our institution.


RESULTS
Twenty-four patients (13 with HAE, 10 with AAE, and 1 with unspecified angioedema) underwent 38 instances of general anesthesia with airway manipulation. All except 4 received prophylactic therapy. One patient, a 67-year-old woman who was pretreated with stanozolol and fresh frozen plasma required reintubation after postoperative airway edema developed.


CONCLUSIONS
Life-threatening episodes of angioedema of the airway occur infrequently, but they can occur in patients who received pretreatment and in patients who have previously undergone anesthesia uneventfully. Anesthesiologists must be ready to emergently manage a difficult airway and must be familiar with recommendations provided in consensus guidelines for the treatment of HAE and AAE patients.
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Lisa S
LS
MacBeth
Division of Allergic Disease, Mayo Clinic, Rochester, MN.
Gerald W
GW
Volcheck
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Juraj
J
Sprung
Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: weingarten.toby@mayo.edu.
Toby N
TN
Weingarten
D058109:Airway Management / Q000009:adverse effects*; D000728:Androgens / Q000627:therapeutic use; D000768:Anesthesia, General / Q000009:adverse effects*; D000799:Angioedema / Q000209:etiology* / Q000517:prevention & control; D054179:Angioedemas, Hereditary / Q000209:etiology* / Q000517:prevention & control; D001920:Bradykinin / Q000378:metabolism; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use; D056947:Enzyme Replacement Therapy; D005260:Female; D006801:Humans; D059035:Perioperative Period; D010949:Plasma; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome
D000728:Androgens; D050718:Complement C1 Inhibitor Protein; D001920:Bradykinin
Acquired angioedema; General anesthesia; Hereditary angioedema