Successful anesthetic management during abdominal wall-lifting laparoscopic cholecystectomy in a patient with hereditary angioedema

BACKGROUND: Hereditary angioedema is a rare genetic disorder resulting from an inherited deficiency or dysfunction of the C1-esterase inhibitor. In the anesthetic management of such patients, special caution should be exercised while attempting tracheal intubation because it may cause mucosal edema in the upper airway. CASE PRESENTATION: A 52-year-old female with hereditary angioedema was scheduled for laparoscopic cholecystectomy. C1-esterase inhibitor, Danazol, tranexamic acid, and prednisolone were administered on the day of surgery. An epidural catheter was inserted through the intervertebral space at T9/10, and spinal anesthesia was instilled via the L3/4 intervertebral space. A single-hole, Nishii-type lifting laparoscopic surgery, without pneumoperitoneum (i.e., gasless) was completed uneventfully. CONCLUSION: This report described the successful management of a patient with hereditary angioedema who underwent laparoscopic cholecystectomy using spinal-epidural anesthesia without tracheal intubation and lift type laparoscopic surgery. This approach to anesthetic management could be indicated in cases with a similar presentation.