Anesthesia experience of surgery in patients with giant amylase

【Case】

A 51-year-old male was admitted to the hospital with a retractable right inguinal mass for 3 months.

Admission diagnosis: right inguinal oblique hernia.

Planned procedure : Minimally invasive inguinal hernia patch repair.

Preoperative examination : blood routine, liver and kidney function electrolytes, coagulation function, etc. are all normal. Only the blood amylase abnormally increased to 1350, which is more than ten times higher than normal, while the urine lipase is normal. The attending physician was puzzled. The next day, the blood amylase was still as high as 1523, and the lipase was also normal, excluding laboratory errors; the next day, the upper abdomen was enhanced CT, the liver, gallbladder, pancreas and spleen were normal, and the urine amylase was still normal; still not at ease, a parotid ultrasound was performed, and no abnormalities were found. The attending physician felt that the blood amylase was so high, and it was not certain whether it was pancreatitis, so he did not dare to arrange surgery rashly. With doubts, on the sixth day of the patient's admission, the Medical Department organized relevant departments for MDT discussion. The doctors participating in the MDT went to the patient's bedside for rounds: the trunk and face were flushed, and faded when pressed. When asked about the past, he said that this situation had been going on for many years, and he had no discomfort; there was no abdominal pain, and no digestive symptoms.

After analysis and discussion, it was concluded that this patient was most likely suffering from an autoimmune disease. The skin flushing was caused by congestion of the skin capillaries, immune damage, and the amylase in the blood combined with specific antibodies, which could not pass through the glomerular filtration. Therefore, the blood amylase laboratory test was elevated, while the amylase urine was normal. His blood lipase was not high, which meant that there was no pathological change in the pancreas, but that the normal product of the pancreas, the amylase in the blood combined with large molecular proteins, could not be excreted from the body through the kidneys!

Diagnosis : giant amylase. As the underlying disease for indirect hernia surgery, blood sedimentation rate or autoimmune examination can be performed. The general surgeon asked: Since it is an autoimmune disease, can the hernia patch still be used? The anesthesiologist asked: Since it is an autoimmune disease, are there other surgical methods? For example, non-minimal invasive surgery under spinal block? After summarizing the opinions of all parties, various concerns were eliminated through discussion and analysis, and an emergency treatment plan was prepared: the patient underwent laparoscopic-assisted hernia repair under general anesthesia the next day, and was fully awake and sent back to the ward after the operation.

【Detailed information about macroamylasemia】

Macroamylasemia is a rare clinical syndrome characterized by the fact that amylase in the blood combines with other macromolecules to form amylase complexes or forms high molecular weight polymers by itself, resulting in persistent hyperamylasemia and no increase or even decrease in urinary amylase concentration.

Definition : Macroamylasemia is a condition in which the amylase circulates in the form of polymers that are too large to be cleared normally by the kidneys.

Symptoms : Symptoms of macroamylasemia are usually not obvious, with occasional abdominal pain. It may be accompanied by liver disease, chronic alcoholism, diabetes, malignant tumors, hyperthyroidism, gluten enteropathy, etc.

Diagnostic basis: persistently elevated serum amylase, normal or decreased urine amylase levels, and decreased amylase clearance in the setting of normal renal function.

Treatment : There is no specific treatment for giant amylasemia, and most of the treatments are symptomatic, such as the use of drugs that inhibit pancreatic secretion: aprotinin, 5-fluorouracil, etc.; at the same time, possible concomitant diseases are treated.

Prevention : Measures include maintaining good living habits, such as a proper diet, regular work and rest schedule, and avoiding exposure to risk factors that may lead to macroamylasemia, such as infection, trauma, etc.

Although macroamylasemia is rare, its diagnosis and treatment require comprehensive consideration of the patient's symptoms, laboratory test results, and related diseases. Patients should seek medical attention promptly when they experience related symptoms in order to receive an accurate diagnosis and appropriate treatment.

Anesthesia for patients with macroamylasemia

Macroamylasemia is a disease caused by excessive concentration of amylase in the blood, which may be related to pancreatic disease, biliary disease, etc. During anesthesia, patients with macroamylasemia need to pay attention to the following points:

1. Preoperative evaluation : Understand the patient's medical history, symptoms, signs, and laboratory test results, assess the patient's overall condition, and develop an appropriate anesthesia plan.

2. Anesthetic drug selection : Avoid using drugs that may aggravate the symptoms of pancreatitis, such as certain nonsteroidal anti-inflammatory drugs. Choose anesthetic drugs that have less impact on pancreatic function.

3. Selection of anesthesia method : According to the patient's specific condition, choose the appropriate anesthesia method, such as general anesthesia, epidural anesthesia or spinal anesthesia.

4. Monitoring during anesthesia : Closely monitor the patient's vital signs, including heart rate, blood pressure, blood oxygen saturation, etc., as well as the patient's pain level and state of consciousness.

5. Prevent complications : Pay close attention to the patient's abdominal symptoms and signs to prevent the occurrence of complications such as acute pancreatitis and pancreatic pseudocysts.

6. Pancreatic protection measures : During anesthesia, some drugs or measures can be used to protect pancreatic function, such as somatostatin, octreotide, etc.

7. Fluid management : Maintain the patient's water and electrolyte balance and avoid dehydration or edema.

8. Postoperative treatment : Closely observe the patient's condition after surgery to detect and deal with possible complications in a timely manner.

9. Communicate with patients : Explain the anesthesia process, precautions and possible risks to patients to gain their trust and cooperation.

【summary】

During the anesthesia process, the special circumstances of patients with macroamylasemia should be fully considered, an appropriate anesthesia plan should be formulated, and the patient's condition should be closely monitored to ensure the patient's safety.

Huang Junming, Department of Anesthesiology, Fenggang Hospital, Dongguan City

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