Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report

Area of Science:

• Anesthesiology
• Rheumatology
• Critical Care Medicine

Background:

• Relapsing polychondritis (RP) is a rare autoimmune condition affecting cartilaginous tissues.
• Surgical procedures in RP patients require careful anesthetic planning due to potential airway complications.

Observation:

• A 42-year-old male with RP developed respiratory failure post-femur fracture surgery under propofol-remifentanil sedation.
• Difficulties with mask ventilation and intubation necessitated a surgical tracheotomy.
• The patient experienced recurrent respiratory failure episodes requiring intensive care unit support.

Findings:

• Anesthesia-induced respiratory depression and potential RP-related airway inflammation contributed to respiratory failure.
• High end-tidal CO2 and respiratory acidosis confirmed severe respiratory compromise.
• Successful management involved ventilatory support and eventual adaptation to bilevel positive-airway-pressure (BiPAP).

Implications:

• This case underscores the critical importance of anticipating and managing airway challenges in relapsing polychondritis patients undergoing anesthesia.
• Advanced airway management strategies and close post-operative monitoring are essential.
• BiPAP may be a viable long-term ventilatory support option for RP patients with persistent respiratory insufficiency.