Kartagener syndrome and anesthetic implications

a pathophysiological review and case report in anterior cervical arthrodesis

Abstract

Primary ciliary dyskinesia (PCD) is an inherited disorder in which motile cilia have structural and/ or functional defects, impairing mucociliary clearance and promoting secretion retention, bacterial colonization, recurrent infections, and chronic inflammation from childhood, with potential progression to bronchiectasis and respiratory failure. Kartagener syndrome (KS) is the classic form associated with PCD, combining chronic respiratory disease with laterality defects such as situs inversus totalis or dextrocardia, which affects the interpretation of ECG, auscultation findings, and imaging studies. Diagnosis is multimodal (clinical features plus specialized tests), and management aims to relieve symptoms and prevent exacerbations (vaccination, respiratory physiotherapy, and airway clearance). We report the case of a 50-year-old patient with KS undergoing anterior cervical fusion, clinically stable and without recent exacerbation. Total intravenous anesthesia (TIVA) with propofol/remifentanil was performed, with rocuronium titrated under train-of-four (TOF) monitoring and depth-of-anesthesia monitoring, alongside lung-protective ventilation and periodic recruitment maneuvers. The course was uneventful, and extubation was performed under strict criteria after complete neuromuscular blockade reversal to ensure effective cough and reduce the risk of mucus plugging/atelectasis. The discussion emphasizes that perioperative complications in KS are predominantly respiratory (atelectasis, bronchospasm, infection) and highlights humidification, secretion management, lung-protective ventilation, complete neuromuscular reversal, adequate analgesia, and early respiratory physiotherapy as key safety measures.