| Modern preoperative and intraoperative management of hereditary angioedema. | |
| | |
MedLine Citation:
|
PMID: 19368763 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Hereditary angioedema (HAE), deficiency of C1 esterase inhibitor, poses a risk of airway compromise during trauma, including surgery, due to activation of the complement cascade. Classical surgical management includes emergent/slash tracheostomy and cricothyrotomy, associated with high complication rates. We provide here an evidence-based review of available medical literature to construct guidelines for managing patients with HAE pre- and intra-operatively. We also describe our experience with a patient for whom we cared using these guidelines. Our objective was to explain new preventive measures to prevent airway compromise in HAE and their level of evidence for averting potential therapeutic misadventure. We analyzed PUBMED literature regarding airway management and etiology of angioedema and its prevention, followed by application of guidelines based on these data in a patient with HAE undergoing inguinal hernia repair. An analysis of contemporary literature yielded key points: (1) using a Cook Exchange catheter to facilitate re-intubation, (2) measuring cuff leak pressure to verify whether airway pressure had increased during surgery, (3) visualizing the airway directly using a fiberoptic laryngoscope connected to a digital flat-screen monitor for real-time assessment, (4) following conventional dictum to double stanozolol dosages 2 weeks before admission, (5) administering fresh frozen plasma pre- and intraoperatively, and (6) preparing recombinant C1 esterase inhibitor for instantaneous intraoperative use; and using FDA-approved human-derived C1-esterase inhibitor prophylactically. Biotechnology in the form of novel but currently available and in-practice medical devices, as well as new therapeutic agents, have expanded the armamentarium for safely managing patients with HAE pre- and intraoperatively. |
| | |
Authors:
|
Anthony M Szema; George Paz; Louis Merriam; Francis Stellaccio; James Jen |
Related Documents
:
|
657853 - A prospective cooperative study of complications following flexible fiberoptic bronchos... 15830773 - Quality improvement in anesthetic practice--incidence of sore throat after using small ... 16633823 - Late complications of circumcision in iran. |
Publication Detail:
|
Type: Journal Article; Review Date: 2009-04-14 |
Journal Detail:
|
Title: Allergy and asthma proceedings : the official journal of regional and state allergy societies Volume: 30 ISSN: 1088-5412 ISO Abbreviation: Allergy Asthma Proc Publication Date: 2009 May-Jun |
Date Detail:
|
Created Date: 2009-06-24 Completed Date: 2009-08-10 Revised Date: 2009-11-19 |
Medline Journal Info:
|
Nlm Unique ID: 9603640 Medline TA: Allergy Asthma Proc Country: United States |
Other Details:
|
Languages: eng Pagination: 338-42 Citation Subset: IM |
Affiliation:
|
Department of Medicine, State University of New York Stony Brook School of Medicine, Stony Brook, New York 11794-8161, USA. anthony.szema@stonybrook |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Angioedemas, Hereditary
/
drug therapy*,
surgery Complement C1 Inhibitor Protein / administration & dosage, therapeutic use* Humans Practice Guidelines as Topic* Recombinant Proteins / administration & dosage, therapeutic use* |
| Chemical | |
Reg. No./Substance:
|
0/Complement C1 Inhibitor Protein; 0/Recombinant Proteins |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Balloon dilation of neonatal critical aortic valvar stenosis via the umbilical artery.
Next Document: Reviewing molecular adaptations of Lyme borreliosis spirochetes in the context of reproductive fitne...