Tailored Anesthetic Management in a Patient With Birt-Hogg-Dubé Syndrome: Navigating the Risk of Pneumothorax and Renal Dysfunction in a Case Report

TL;DR

This case report describes tailored anesthetic strategies to manage a patient with Birt-Hogg-Dubé syndrome and chronic kidney disease, avoiding complications like pneumothorax and renal failure.

Contribution

The paper presents a novel approach to anesthetic management in BHDS patients with renal transplants, emphasizing strategies to protect lung and kidney function.

Findings

Spinal and regional anesthesia were used to reduce risks in surgeries for a BHDS patient.

Lung-protective ventilation and controlled extubation prevented pneumothorax during procedures.

Renal-protective strategies successfully preserved kidney function in a post-transplant patient.

Abstract

Birt-Hogg-Dubé syndrome (BHDS) is a rare genetic disorder characterized by multiple pulmonary cysts, increasing the risk of pneumothorax under positive pressure ventilation. We report a case of a 50-year-old woman with BHDS, recurrent pneumothorax, and post-renal transplant chronic renal failure, who underwent three surgeries within three years. Anesthetic management was tailored to minimize the risk of pneumothorax and deterioration of renal function, including spinal anesthesia for cervical conization, combined epidural-general anesthesia with lung-protective ventilation for open sigmoid colectomy, and general anesthesia with peripheral nerve blocks for an emergency Hartmann’s procedure. Careful ventilation strategies, controlled extubation using a supraglottic airway under deep anesthesia, and renal-protective management employing regional anesthesia successfully prevented perioperative complications. This case highlights the need for individualized anesthetic management in BHDS patients with renal transplants, emphasizing careful strategies to protect both pulmonary and renal function.

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