Anesthesia During Functional Endoscopic Sinus Surgery for Kartagener's Syndrome: A Case Report and Literature Review

Kartagener's syndrome (KS) is a ciliopathic, autosomal recessive disorder characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. The abnormal ciliary structure and function lead to variable clinical manifestations, including dextrocardia, pneumonia, bronchitis, chronic rhinosinusitis, otitis media, reduced fertility in women, and infertility in men. This article reports our experience on general anesthesia with endotracheal intubation during functional endoscopic sinus surgery (FESS) in a patient with KS.

A 44-year-old man was admitted to our hospital with chronic nasal obstruction, postnasal drip, chronic sinusitis, and chronic non-productive cough for FESS. The patient's heart was on the right side of his chest. A chest roentgenogram and a high-resolution chest and abdomen computed tomography (CT) scan identified dextrocardia, situs inversus, and chronic bronchitis and bronchiectasis involving both lung bases. CT sinuses showed mucosal thickening of bilateral maxillary and ethmoid and sphenoid sinuses. The patient was prescribed oral medications and nasal spray for crepitations and wheezes heard over bilateral lung fields. Intensive chest physiotherapy and supportive care prior to surgery were provided to prevent worsening of lung function. FESS with bilateral frontal polypectomy was performed. All hemodynamic parameters were stable. The emergence from anesthesia was smooth. After ~20 minutes in the post-anesthesia care unit, the patient was fully awake and pain-free. He was then transferred to the surgical intensive care unit and subsequently to the ward. The postoperative period was uneventful. The patient felt subjectively "very well" and was discharged from the hospital on the 2nd postoperative day.

Anesthesiologists must be aware of cardiopulmonary inversion that could challenge the management of patients with KS. To avoid respiratory depression caused by long-acting systemic opioids, we suggest using short-acting opioids during general anesthesia and for postoperative pain relief.