Maynard Andrew A, Burger Christina F, Schlesinger Joseph J
Department of Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
College of Pharmacy, The University of Tennessee, Memphis, TN, USA.
SAGE Open Med Case Rep. 2017 Jun 8;5:2050313X17713912. doi: 10.1177/2050313X17713912. eCollection 2017.
To describe the perioperative management of a patient with acquired angioedema (AAE).
A 66-year-old Caucasian male presented from an outside hospital with a history of acquired angioedema and gastrointestinal stromal tumor-related intractable urticaria and mastocytosis. He was admitted for urgent laparoscopic partial gastrectomy, secondary to gastric outlet obstruction symptomatology. Previous combined attacks were characterized by a widespread rash, abdominal pain and respiratory distress resulting in hospitalization. Following preoperative consultation with the patient's allergist and a hospital pharmacist, he was treated preoperatively with fresh frozen plasma and his home prednisone dose. C1-inhibitor (Berinert®) was on standby along with epinephrine, given that the underlying etiology (C1- inhibitor deficiency vs histaminergic) was not known.
There were no intraoperative complications, and the patient was discharged home 3 days after the procedure.
Optimization of perioperative outcomes in patients, especially during urgent or emergent surgery, with a history of angioedema requires the development of a patient-specific perioperative plan, including prophylaxis, rescue therapies and opioid-sparing strategies.
描述1例获得性血管性水肿（AAE）患者的围手术期管理。
一名66岁的白种男性从外院转入，有获得性血管性水肿病史，以及胃肠道间质瘤相关的难治性荨麻疹和肥大细胞增多症。因胃出口梗阻症状，他入院接受紧急腹腔镜下部分胃切除术。既往合并发作的特点为广泛皮疹、腹痛和呼吸窘迫，导致住院治疗。在术前与患者的过敏症专科医生和医院药剂师会诊后，他术前接受了新鲜冰冻血浆和其在家服用的泼尼松剂量治疗。鉴于潜在病因（C1抑制剂缺乏与组胺能）不明，C1抑制剂（贝林妥欧®）与肾上腺素一起备用。
术中无并发症，患者术后3天出院回家。
对于有血管性水肿病史的患者，尤其是在急诊或紧急手术期间，优化围手术期结局需要制定针对患者的围手术期计划，包括预防措施、抢救治疗和阿片类药物节省策略。
