Enhanced Recovery through Multimodal Anesthesia in a CDH1 Mutation Carrier with Previous Bariatric Surgery UndergoingGastrectomy

Abstract

This study highlights the complexity of perioperative management for CDH1 patients undergoing prophylactic total gastrectomy (PTG) due to the extensive surgery and associated morbidity. Endoscopic surveillance often fails to detect cancers, with studies showing 59.5% of cases remain undiagnosed preoperatively, reinforcing PTG’s necessity. A 62-year-old female ASA III with a previous Roux-en-Y gastric bypass (RYGB) presented for PTG. Given her surgical history, aa precise anesthesia plan was premediated with gabapentin and acetaminophen; celecoxib was omitted. Epidural anesthesia (EA) was used for intraoperative pain control, with aa lidocaine bolus (60mg) administered via epidural catheter five minutes before incision, followed by a 2 % lidocaine infusion (3-4 ml/hour), magnesium sulfate, and acetaminophen. No additional opioids were required. The surgery and postoperative course were uneventful. Multimodal anesthesia proved beneficial, providing effective pain control, reduced opioid use, and enhancing recovery. Given opioids’ detrimental effects on gastrointestinal function, CDH1 mutation carries require a comprehensive anesthesia strategy to reduce gastric cancer risk and surgical complications. This case underscores the importance of personalized anesthesia management.