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Case report
Anaesthetic management of a patient with eosinophilic granulomatosis with polyangiitis for internal fixation of a fractured femur
  1. Hassan Mohamed1,2,
  2. Euan CE Ó Mathúna3,
  3. Hany Elbardesy4 and
  4. George Shorten5,6
  1. 1Department of Anaesthesia, Intensive Care and Pain Management, Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt
  2. 2Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
  3. 3School of Medicine, National University of Ireland Galway, Galway, Ireland
  4. 4Department of Orthopaedics, Cork University, Cork, Ireland
  5. 5Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland
  6. 6Department of Anaesthesia, University College Cork, Cork, Ireland
  1. Correspondence to Dr Hassan Mohamed; hassan.ahmed7{at}nhs.net

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease with an estimated annual incidence of 0.5–6.8 per million. It is characterised by necrotising vasculitis with multiorgan eosinophilic infiltration. Pulmonary manifestations are the most common presentation of EGPA, and cardiac complications are the most common cause of death. Anaesthetic management of EGPA is challenging due to perioperative pulmonary complications, multiorgan involvement and greater risk of cholinesterase enzyme deficiency. We are reporting the anaesthetic management of a 58-year-old woman, diagnosed with EGPA 3 years ago, who underwent urgent intramedullary nail insertion for a femur fracture. The anaesthetic technique comprised femoral nerve block and spinal anaesthesia, thereby avoiding (1) the need for upper airway manipulation, (2) potential adverse effects of anticholinesterase drugs (for reversal of neuromuscular blockade) and (3) histamine release associated with morphine administration perioperatively. Surgery and anaesthesia were uneventful.

  • anaesthesia
  • vasculitis
  • orthopaedics

https://doi.org/10.1136/bcr-2020-239052

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    Footnotes

    • Twitter @hany elbardesy

    • Contributors HM and EOM wrote the primary manuscript. HE collected the case materials and followed up with the case. GS reviewed and edited the manuscript. All authors have read and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.