2021 Volume 49 Issue 3 Pages 111-113
Cryopyrin-associated periodic syndrome (CAPS) is an autosomal dominant inherited disorder characterized by repetitive systemic inflammation. The representative symptoms include fever, fatigue, rashes, headaches and arthralgia, which appear as familial cold auto-inflammatory syndrome (FCAS). FCAS symptoms are triggered by cold stimulation and continue for a few hours or several days. We experienced a surgical case of a 13-year-old female with FCAS. The patient had been treated with canakinumab (IL-1 inhibitor) every two months in the winter, and her symptoms were under control. Since a reduction in body temperature was a concern, we planned to monitor the patient's temperature intraoperatively at the axilla, superficial temporal artery, and rectum. We started by prewarming the patient using a forced-air warming system before the anesthesia induction. General anesthesia was maintained with air-oxygen-sevoflurane and intravenous remifentanil. The initial axillary temperature was 36.0℃, but her temperature rose to 37.6℃ at 45 minutes after the anesthesia induction. The superficial temporal artery temperature rose gradually from 36.6℃ to 37.1℃. The rectal temperature was stable at between 37.4℃ and 37.5℃ throughout. The temperature at these three locations differed by as much as 2℃ at the start of surgery, but the use of forced air warming decreased this difference to 0.4℃ at 60 minutes after the anesthesia induction. The durations of the surgery and anesthesia were 37 minutes and 1 hour, 17 minutes, respectively, and a low body temperature was successfully avoided. The patient was discharged from hospital on the following day without any symptoms of FCAS.
