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Background and Aims Anti-synthetase syndrome (ASS ) is a rare chronic autoimmune disorder of unknown cause. The hallmark of ASS is the presence of serum autoantibodies directed against amino act-tRNA synthetase. ASS is 2-3 times more common in women than in men. The morbidity and mortality of ASS are usually linked to pulmonary findings .
Methods 48 years old lady who was diagnosed having Anti -Synthetase syndrome in 2020. She has interstitial lung disease with pulmonary function test of FeV1 1.4 (61%) FVC 1.65 (61%) and DLLO 40% .She was scheduled for total laparoscopic hysterectomy and salphingoophrectomy . She was assessed by respiratory unit pre operative where surgical risk was moderate , aim for early mobilisation and suggested for spinal anaesthesia if possible . Rheumatologist was also consulted preoperatively .The surgery was conducted under general anaesthesia with IPPV and securing the airway , neuromuscular blockade monitoring and surgeon was told to be careful with the intraabdominal pressure . The surgery went well she was extubated with sugamadex .
Conclusions ASS is a rare idiopathic inflammatory multi system disorder which can lead to serious postoperative complications secondary to muscle weakness and respiratory complications. As laparoscopic surgery requires inflation of gas to intra abdominal cavity and head down position during the surgery
, regional anaesthesia would be a challenge for this patient . A multidisciplinary teams including respiratory unit , rheumatology , physiotherapist and anaesthesiology is essential in the care of a patient with ASS.
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