Anesthetic management of patient with congenital insensitivity to pain with anhidrosis (CIPA) by using BIS monitor: A case report

Jo, Jae Keun; Lim, Yun Hee; Kim, Hyung Joon; Yon, Jun Heum; Woo, Seung Hoon; Kim, Kye Min

Case Report

Pediatric Anesthesia

Anesthesia and Pain Medicine 2011;6(2):186-190.
Published online April 30, 2011.

Anesthetic management of patient with congenital insensitivity to pain with anhidrosis (CIPA) by using BIS monitor: A case report

Jae Keun Jo, Yun Hee Lim, Hyung Joon Kim, Jun Heum Yon, Seung Hoon Woo, Kye Min Kim

Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea. painfree@paik.ac.kr

Abstract

Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, is characterized by inability to sweat, insensitivity to pain, recurrent episodes of hyperpyrexia, self-mutilation and mental retardation. Because of lacking autonomic response to painful stimuli, it is difficult to determine adequate depth of anesthesia in patients with CIPA. We report an anesthetic experience for child with CIPA who had undergone an orthopedic operation. Anesthesia was induced by propofol and maintained by Sevoflurane with 50% nitrous oxide and anesthetic depth was monitored by using bispectral index (BIS). Throughout the operation, anesthesia was maintained with low end-tidal Sevoflurane concentrations (<1.5 vol%), BIS was within 28-62 and vital signs were stable. After operation, he did not remember anything about the surgery. The BIS monitor may be a useful tool to guide the adequate depth of anesthesia for the patient with CIPA.

Key Words: Bispectral index, Congenital insensitivity to pain with anhidrosis, General anesthesia