Abstract Managing patients with multiple comorbidities, such as hypothyroidism, chronic obstructive pulmonary disease (COPD), and primary membranous nephropathy, presents significant anesthetic challenges. Hypoalbuminemia, pulmonary compromise, and endocrine instability increase surgical risk. In this case report, we present a 63-year-old male with longstanding hypothyroidism, moderate-to-severe COPD, hypertension, and primary membranous nephropathy on chronic low-dose prednisolone who underwent elective laparoscopic inguinal hernia repair under general anesthesia. Preoperative laboratories showed hypoalbuminemia; chest X-ray revealed emphysematous changes. Perioperative management included stress-dose hydrocortisone, optimized anesthesia, multimodal analgesia, early pulmonary rehabilitation, and high-protein nutritional support. Surgery was uneventful; the patient was extubated in the operating room and transferred to the recovery room. This case underscores the importance of a multidisciplinary, evidence-informed perioperative strategy that addresses endocrine, pulmonary, nutritional, and steroid-related concerns to ensure safe surgical outcomes in complex, high-risk patients.
Gangwar et al. (Thu,) studied this question.