#36390 A case of Anti Synthetase Syndrome with Interstial lung disease for laparoscopic surgery

Zanariah Yahaya
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Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes

Background and Aims

Anti-synthetase syndrome (ASS ) is a rare chronic autoimmune disorder of unknown cause. The hallmark of ASS is the presence of serum autoantibodies directed against amino act-tRNA synthetase. ASS is 2-3 times more common in women than in men. The morbidity and mortality of ASS are usually linked to pulmonary findings .

Methods

48 years old lady who was diagnosed having Anti -Synthetase syndrome in 2020. She has interstitial lung disease with pulmonary function test of FeV1 1.4 (61%) FVC 1.65 (61%) and DLLO 40% .She was scheduled for total laparoscopic hysterectomy and salphingoophrectomy . She was assessed by respiratory unit pre operative where surgical risk was moderate , aim for early mobilisation and suggested for spinal anaesthesia if possible . Rheumatologist was also consulted preoperatively .The surgery was conducted under general anaesthesia with IPPV and securing the airway , neuromuscular blockade monitoring and surgeon was told to be careful with the intraabdominal pressure . The surgery went well she was extubated with sugamadex .

Conclusions

ASS is a rare idiopathic inflammatory multi system disorder which can lead to serious postoperative complications secondary to muscle weakness and respiratory complications. As laparoscopic surgery requires inflation of gas to intra abdominal cavity and head down position during the surgery , regional anaesthesia would be a challenge for this patient . A multidisciplinary teams including respiratory unit , rheumatology , physiotherapist and anaesthesiology is essential in the care of a patient with ASS.

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#36390腹腔镜手术抗合成酶综合征合并间质性肺病1例
申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的抗合成酶综合征(ASS)是一种罕见的慢性自身免疫性疾病,原因不明。ASS的标志是血清中存在针对氨基- trna合成酶的自身抗体。ASS在女性中的发病率是男性的2-3倍。ASS的发病率和死亡率通常与肺部表现有关。方法2020年确诊为抗合成酶综合征的48岁女性。她患有间质性肺疾病,肺功能检查FeV1 1.4 (61%) FVC 1.65 (61%) dlo 40%,计划行腹腔镜全子宫切除术和脑脊膜切除术。术前由呼吸科评估,手术风险中等,目标是早期活动,并建议在可能的情况下进行脊髓麻醉。术前还咨询了风湿病学家。手术是在全麻下进行的,有IPPV和固定气道,神经肌肉阻滞监测,外科医生被告知要小心腹内压。手术进行得很顺利,她拔管时用了糖糖。结论ASS是一种罕见的特发性炎性多系统疾病,可导致严重的术后并发症,继发于肌肉无力和呼吸系统并发症。由于腹腔镜手术需要向腹腔内充气,手术过程中需要头部朝下,因此局部麻醉对该患者来说是一个挑战。包括呼吸科、风湿病科、物理治疗师和麻醉科在内的多学科团队在ASS患者的护理中至关重要
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