Anaesthetic problems

1. Patients may present with acute upper airway compromise from laryngeal oedema (Jensen & Weiler 1998). Emergency tracheostomy may be needed (Hamilton et al 1977). Severe postoperative angioedema occurred in a 61-year-old man after cervical surgery, performed because osteophytes were thought to be causing dysphagia and choking episodes (Krnacik & Heggeness 1997). Fatal obstruction occurred in a 27 year old on ITU, whilst preparations for tracheostomy were being made (Nielsen et al 1995).

2. Dental or surgical procedures, tracheal intubation or other trauma, all carry the risk of initiating an attack. Fatal laryngeal oedema has been reported after dental extraction (Wall et al 1989). Death, secondary to exaggerated complement common pathway activation, occurred during cardiopulmonary bypass in one patient whose C1 EI levels were 30% normal (Bonser et al 1991), whereas another patient in whom they were 75% had uneventful cardiac surgery (Haering & Communale 1993). It was suggested that haemodilution of existing low levels contributed to the fatality.

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