# Spinal Anesthesia in a Respiratory-Compromised Patient With Fabry Disease Undergoing Umbilical Hernia Repair: A Case Report

## TL;DR

A 42-year-old woman with Fabry disease and breathing issues safely underwent spinal anesthesia for hernia surgery, showing it can be a viable option with careful monitoring.

## Contribution

Demonstrates the safe use of spinal anesthesia in a high-risk Fabry disease patient for abdominal surgery.

## Key findings

- Spinal anesthesia achieved a T6 sensory level without complications in a patient with Fabry disease.
- The patient maintained hemodynamic stability without vasopressor support.
- This case supports the use of neuraxial anesthesia in FD for procedures requiring higher dermatomal levels.

## Abstract

Fabry disease (FD) is a rare X-linked lysosomal storage disorder associated with multisystemic involvement, making anesthetic management challenging due to potential cardiomyopathy, renal insufficiency, and airway difficulties. We present the case of a 42-year-old female patient with FD and significant respiratory comorbidities, including active smoking and moderate-to-severe airflow obstruction (FEV1: 50% predicted), alongside a body mass index (BMI) of 32.3 kg/m², presenting for umbilical hernia repair. Given the high risk of perioperative respiratory complications, spinal anesthesia was selected. A subarachnoid block performed at L2-L3 achieved a T6 sensory level. The patient maintained hemodynamic stability without vasopressor support and experienced no respiratory or neurological complications. This case contributes to the scarce literature on neuraxial anesthesia in FD, demonstrating that spinal anesthesia can be safely extended to abdominal wall procedures requiring higher dermatomal levels (T6), provided that hemodynamic monitoring is rigorous.