Anaesthetic Considerations for a Patient with Kartagener’s Syndrome Undergoing Emergency Surgery: A Case Report

Kartagener Syndrome (KS) is a rare genetic disorder resulting from autosomal recessive inheritance and is characterised by ciliary dyskinesia. It typically presents with the distinctive triad of chronic sinusitis, situs inversus, and bronchiectasis. KS poses distinct challenges during the perioperative period due to its potential impact on pulmonary function and cardiovascular anatomy. The present case details the successful perioperative management of a 55-year-old male patient with KS who underwent emergency knee-spanning external-fixator application under regional anaesthesia. The patient’s medical history included a chronic diagnosis of bronchiectasis, for which he was on irregular medications. His clinical examination revealed Grade 2 digital clubbing. Auscultation findings included heart sounds auscultated on the right hemithorax, with the apical impulse palpable in the right fourth intercostal space, indicative of dextrocardia associated with situs inversus. Diagnosis of Kartagener syndrome was confirmed with Computed Tomography (CT), which showed the cardiac apex and aortic notch on the right side and bronchiectasis changes predominantly involving the bilateral lower lobes. Given the immediate need for surgery, neuraxial anaesthesia under ultrasound guidance was planned to address the patient’s complex respiratory profile. In this case, employing a combined spinal-epidural anaesthesia technique facilitated effective pain management and haemodynamic stability while minimising the respiratory complications typically associated with general anaesthesia.