Anesthesia in patient with lead poisoning: case report

Area of Science:

• Toxicology
• Anesthesiology
• Neurology

Background:

• Lead poisoning (Saturnism) often stems from occupational exposure or retained projectiles.
• Chronic lead exposure can elevate plasma lead levels, leading to significant clinical manifestations, especially neurological deficits.
• Undiagnosed lead poisoning poses risks, particularly during medical evaluations and procedures.

Observation:

• A patient presented for surgery to remove a bullet lodged 14 years prior, exhibiting undiagnosed polyneuropathy.
• During preanesthetic evaluation, Saturnism was suspected and confirmed by elevated plasma lead levels (129 μg.dL(-1)).
• Anesthesia was administered prior to chelation therapy; the patient experienced apnea post-fentanyl administration.

Findings:

• Retained projectiles can be a source of chronic lead poisoning.
• Lead poisoning significantly impacts neurological function, evidenced by polyneuropathy and reduced neural conduction.
• Anesthetic management requires careful consideration in patients with lead poisoning due to potential complications.

Implications:

• Early diagnosis of lead poisoning is crucial, even in asymptomatic cases or those presenting for unrelated issues.
• Anesthesiologists must be aware of the risks associated with lead poisoning, including potential respiratory complications.
• Understanding lead's systemic effects, particularly on neurological and metabolic pathways, is vital for patient care.