General Anesthesia for Patients With Cyclic Vomiting Syndrome and Obesity: A Case Report

Area of Science:

• Anesthesiology
• Gastroenterology
• Endocrinology

Background:

• Cyclic vomiting syndrome (CVS) presents challenges in perioperative management, particularly when co-occurring with obesity.
• Managing patients with CVS and obesity under general anesthesia requires meticulous planning to mitigate risks like postoperative nausea and vomiting (PONV).

Observation:

• A case report details the anesthetic management of a 21-year-old female with CVS, obesity (BMI 35), and intellectual disability undergoing dental surgery.
• Surgery was timed during a period of CVS remission.
• Preoperative and postoperative hormone levels (ACTH, ADH, cortisol) were monitored to assess hypothalamic-pituitary-adrenal (HPA) axis response to surgical stress.

Findings:

• The patient received general anesthesia with remifentanil, propofol, and rocuronium, alongside local anesthesia for the dental procedures.
• Postoperative agitation was managed with midazolam, and importantly, no vomiting occurred.
• Serum hormone levels remained stable, indicating no significant HPA axis activation, suggesting the anesthetic approach mitigated surgical stress.

Implications:

• This case underscores the necessity of tailored perioperative strategies for patients with CVS and obesity.
• The use of midazolam may be a valuable tool in suppressing HPA axis activation and preventing PONV in this patient population.
• Monitoring stress hormone levels provides insight into the physiological response to anesthesia and surgery in patients with complex comorbidities.