Anesthesia in patient with shrinking lung syndrome: case report

The incidence of pulmonary involvement in systemic lupus erythematosus (SLE) may be presented as a syndrome called shrinking lung syndrome (SLS). SLS has quite a controversial pathophysiology, which can induce to a mechanical ventilation dependency. Due to its rarity, there is a limited number of publications on the subject. The objective of this report is to present the case of a patient with SLS who underwent incisional hernia repair under epidural anesthesia.

Female patient with SLE, hypertensive and obese, diagnosed with SLS 18 years ago. She was dependent on nocturnal oxygen at home, had dyspnea on minimal exertion and spirometry with severe restrictive ventilatory defect. In a previous post-operative period under general anesthesia, she remained on mechanical ventilation for 9 days with difficult weaning. She underwent incisional hernia repair for 3 hours under thoracic epidural anesthesia without any pre- or post-operative respiratory complication.

Shrinking lung syndrome is a rare disease that requires a prior knowledge of the clinical and laboratory history of the patient by the anesthesiologist. The thoracic epidural anesthesia technique proved to be a satisfactory option for this patient, with highly satisfactory respiratory evolution.