Anesthesia for a patient with Kartagener's syndrome undergoing ambulatory bilateral breast cancer surgery
Kartagener's syndrome is an inherited disease characterized by a triad of symptoms, bronchiectasis, situs inversus and sinusitus. We report a case of a 53-year-old woman with the syndrome who received bilateral simple mastectomies and axillary lymph node dissections on ambulatory basis. She received antibiotic treatment until the day of surgery. She was admitted to our day surgery unit with productive cough and rales on both lungs on the day of surgery. General anesthesia was induced and maintained with propofol, fentanyl and vecuronium. Laryngeal mask airway (LMA) was placed. She received rectal diclofenac and bupivacaine infiltration into surgical field for pain relief. During pressure controlled ventilation, EtCO2, blood pressure and heart rate increased and SpO2 decreased gradually. These symptoms were resolved after resumption of spontaneous ventilation. She coughed out phlegm in LMA during surgery. The sputa were sucked out using bronchofiberscope. She made an uneventful recovery although she had productive cough preoperatively. She was discharged from the hospital without respiratory complication after overnight observation.