Evaluation of Catecholamine and Cortisol Plasma Level in Patient with Congenital Insensitivity to Pain during Total Knee Arthroplasty

Abstract

Congenital insensitivity to pain（CIP）is an extremely rare disease characterized by the loss of nociception mainly in the extremities. There is no consensus regarding the safety of anesthesia or the intraoperative analgesic needs of patients with CIP. We administered general anesthesia to a 49-year-old man with CIP undergoing total knee arthroplasty. We anesthetized the patient with total venous anesthesia using propofol and remifentanil. We measured the patient’s plasma concentration of adrenaline, noradrenaline, dopamine, and cortisol as stress hormones during and after anesthesia. In this case, a low dose of remifentanil could stabilize the hemodynamics and concentration of stress hormones. The response other than nociception induced by noxious stimuli, such as the autonomic reflex and stress hormone release, could also be attenuated. Therefore, patients with CIP need more optimized management of anesthesia.