Akdoğan A, Eroğlu A, Kutanis D, Cekic B (2016) Anesthetic Management in a Patient with Congenital Insensitivity to Pain Syndrome for Lower Extremity Surgery. Int J Anesth Res. 4(10), 340-342.
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OPEN ACCESS http://scidoc.org/IJAR.php
International Journal of Anesthesiology & Research (IJAR)
ISSN 2332-2780
Anesthetic Management in a Patient with Congenital Insensitivity to Pain Syndrome for Lower
Extremity Surgery
Case Report
Akdoğan A, Eroğlu A
*
, Kutanis D, Cekic B
Karadeniz Technical University, Anesthesiology and Intensive Care Medicine, Trabzon, Turkey.
*Corresponding Author:
Ahmet Eroglu,
Karadeniz Technical University, Anesthesiology and Intensive Care Medicine, Trabzon, Turkey.
E-mail: aheroglu@hotmail.com
Received: July 04, 2016
Accepted: October 13, 2016
Published: October 18, 2016
Citation: Akdoğan A, Eroğlu A, Kutanis D, Cekic B (2016) Anesthetic Management in a Patient with Congenital Insensitivity to Pain Syndrome for Lower Extremity Surgery. Int J Anesth
Res. 4(10), 340-342. doi: http://dx.doi.org/10.19070/2332-2780-1600070
Copyright: Eroğlu A
©
2016. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution
and reproduction in any medium, provided the original author and source are credited.
Introduction
Congenital insensitivity to pain (CIP), irst described by Dearborn
in the year 1932, is a rarely encountered neuropathic syndrome
that manifests itself starting from birth and is characterized
by unresponsiveness to painful stimulants, anhydrous, mental
retardation, and recurring feverish episodes [1].
The cases usually involve painless fractures, inger, lip and tongue
injuries, neurogenic arthropathies (Charcot joint), and joint
deformities that could lead to chronic osteomyelitis [2]. The
mortality rate of the disease is very high due to the fact that there
is no speciic treatment that could be administered. The subjects
are usually deceased by the time they reach their adolescence.
In cases where the subjects are required to go through a surgical
procedure, in spite of the fact that the patient is unresponsive to
pain, it would still be necessary to administer anesthesia to prevent
unwanted circumstances such as tactile hyperesthesia.
We would like to present our experiment regarding anesthesia
management under Bispectral index (BIS) monitoring in a patient
with congenital insensitivity to pain for lower extremity procedure
due to osteomyelitis.
Case Presentation
The plastic surgery clinic planned to operate on a 16 year old
60 kg male patient in ASA II group suffering from congenital
insensitivity to pain and diagnosed previously with osteomyelitis
development in the left patellar region (Figure 1).
In the preoperative assessment of the patient, the laboratory
values and lungs were normal. The patient, who was subjected
to physical examination, was insensitive to pain and temperature
and displayed slight mental retardation. His other neurologic
examination results and his sense of touch were normal. The
airway evaluation revealed Mallampati classiication to be III and
sternomental distance to be 10 cm, while the neck movements
were determined to be restricted.
Prior to the procedure, the patient’s family members were
informed of the anesthesia method to be applied and the potential
risks and their consent was obtained.
Fiberoptic bronchoscope, laryngeal mask and tubes of various
Abstract
Congenital insensitivity to pain (CIP) is a rarely syndrome and is characterized by unresponsiveness to painful stimulants,
anhydrous, mental retardation, and recurring feverish episodes. In this case report we presented our anesthesia management
in a patient with congenital insensitivity to pain for lower extremity surgery due to osteomyelitis.
Keywords: Congenital Insensitivity to Pain (CIP) Syndrome; Anesthesia; Lower Extremity Surgery.