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Jordan JH, Pedroza S, Billefals ES, Cruz G. Diffuse alveolar hemorrhage induced by inhaled Sevoflurane. Case report and literature review. Respir Med Case Rep 2023; 45:101906. [PMID: 37609002 PMCID: PMC10440581 DOI: 10.1016/j.rmcr.2023.101906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
Diffuse alveolar hemorrhage secondary to sevoflurane inhalation is a rare condition. It should be considered in postoperative patients presenting symptoms of hemoptysis, hypoxemia, or radiographic alveolar infiltrates. We present the case of a 42-year-old man who experienced a diffuse alveolar hemorrhage following sedation with sevoflurane during a low-risk orthopedic procedure. Initially, the patient presented hemoptysis, hypoxemia, and dyspnea. X-ray findings suggested alveolar hemorrhage and the diagnosis was confirmed with fiberoptic bronchoscopy. The patient improved under the care of the pulmonary service and was discharged. Early identification and management of this respiratory complication were crucial for a successful recovery.
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Affiliation(s)
- Jaime H. Jordan
- Fundación Valle del Lili, Departamento de anestesiología, Cra 98 No. 18 - 49, Cali, 760032, Colombia
| | - Santiago Pedroza
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18 - 49, Cali, 760032, Colombia
| | - Einar S. Billefals
- Fundación Valle del Lili, Departamento de anestesiología, Cra 98 No. 18 - 49, Cali, 760032, Colombia
| | - Gustavo Cruz
- Fundación Valle del Lili, Departamento de anestesiología, Cra 98 No. 18 - 49, Cali, 760032, Colombia
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Ahmed-Khan M, Moin K, Funk C, Sachdev M, Jiffry MZM. Sevoflurane-Induced Diffuse Alveolar Hemorrhage. Arch Clin Cases 2023; 10:29-31. [PMID: 36926683 PMCID: PMC10012166 DOI: 10.22551/2023.38.1001.10235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary pathology which results in intra-alveolar hemorrhage secondary to disruption of the alveolar capillary basement membrane. Most commonly, these patients present with hemoptysis, hypoxemia and pulmonary infiltrates. Although rare, sevoflurane, an inhalational anesthetic used as a rapid induction agent for anesthesia may be implicated in the etiology of DAH. We report a case of a 21-year-old otherwise healthy male found to have postoperative diffuse alveolar hemorrhage secondary to sevoflurane inhalation. Thus far, only five documented cases describing sevoflurane induced diffuse alveolar hemorrhage have been described in the literature, with prior cases also showing a clear temporal association between sevoflurane administration and symptom onset. Although uncommon, we must take sevoflurane into consideration as a possible etiology of diffuse alveolar hemorrhage when encountering signs of respiratory distress and hemoptysis in postoperative patients.
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Affiliation(s)
- Mohammad Ahmed-Khan
- Danbury Hospital-Yale University, School of Medicine, Danbury, Netherlands Antilles
| | - Kayvon Moin
- American University of the Caribbean, School of Medicine, Cupecoy, Sint Maarten, Netherlands Antilles
| | - Carly Funk
- American University of the Caribbean, School of Medicine, Cupecoy, Sint Maarten, Netherlands Antilles
| | - Mala Sachdev
- American University of the Caribbean, School of Medicine, Cupecoy, Sint Maarten, Netherlands Antilles
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Hao D, Basnet S, Melnick S, Kim J. Negative pressure pulmonary edema-related diffuse alveolar hemorrhage associated with Sevoflurane and cigarette smoking. J Community Hosp Intern Med Perspect 2019; 9:247-251. [PMID: 31258867 PMCID: PMC6586085 DOI: 10.1080/20009666.2019.1608140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Negative-pressure pulmonary edema (NPPE)-related diffuse alveolar hemorrhage (DAH) is an underdiagnosed clinical entity seen with alveolar capillary damage. The pathophysiology of type I NPPE is generation of a negative pleural pressure against an upper airway obstruction. We suspect this process was facilitated by preexisting alveolar damage with smoking and administration of the irritating and coagulopathic inhaled anesthetic sevoflurane. We present a case of a healthy 31-year-old man who developed postoperative hemoptysis, diffuse ground-glass opacity and infiltrates on computed tomography (CT) of the chest, anemia, and hypoxic respiratory failure. A diagnosis of DAH was made and a serologic workup for systemic disorders including vasculitis and connective tissue diseases was negative. The patient rapidly improved with supportive care and had complete resolution of his bilateral infiltrates on repeat chest x-ray two weeks later. Our literature review identified three cases of DAH in the setting of sevoflurane administration. Our case illustrates the importance of including NPPE-related DAH on the differential of post-operative hemoptysis, especially in association with sevoflurane administration and a history of cigarette smoking.
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Affiliation(s)
- David Hao
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Sijan Basnet
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Stephen Melnick
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - James Kim
- Pulmonary and Critical Care Medicine, Respiratory Specialists, Reading, PA, USA
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Han IS, Han BM, Jung SY, Yoon JR, Chung EY. Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period. Acute Crit Care 2018; 33:191-195. [PMID: 31723885 PMCID: PMC6786702 DOI: 10.4266/acc.2016.00689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 01/12/2023] Open
Abstract
Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.
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Affiliation(s)
- In Soo Han
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Mi Han
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Jung
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Rho Yoon
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Yong Chung
- Department of Anestheiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mersh R, Ross C. Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced? BMJ Case Rep 2018; 2018:bcr-2017-222010. [PMID: 29991540 DOI: 10.1136/bcr-2017-222010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Negative pressure pulmonary oedema is well described in the literature as an uncommon but recognised complication of general anaesthe sia; negative pressure diffuse alveolar haemorrhage is a rarer consequence. We report a case of massive haemoptysis following elective general anaesthesia using a laryngeal mask airway device and sevoflurane anaesthetic maintenance. The patient had no obvious signs of laryngospasm or other cause of upper airway obstruction perioperatively. We explore the possibility that the haemoptysis was caused by clinically unapparent negative pressure generation, but also ask whether the anaesthetic agent should be considered as a culprit.
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Affiliation(s)
- Rebecca Mersh
- Anaesthetics, St Mary's Hospital, Paddington, London, UK
| | - Clare Ross
- Respiratory Medicine, St Mary's Hospital, Paddington, London, UK
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Lehnus K. Endotracheal tube obstruction with a blood clot following aspiration of rumen contents in a reindeer. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
SummaryAn apparently otherwise healthy female reindeer was anaesthetised for open reduction and fixation of a hip luxation. The animal developed ruminal bloat which was treated with passage of an orogastric tube that was left indwelling during the procedure. A fluid inspiratory noise was audible two hours after decompression, and clear fluid was suctioned from the airway. It showed no other signs of regurgitation and aspiration of rumen contents intraoperatively, and did not develop obvious respiratory compromise while mechanically ventilated. In recovery, the deer became apnoeic and cyanotic and died suddenly within minutes of being positioned in the recovery box. Just before dying, it coughed a large blood clot out of the endotracheal tube (ETT) . Additional clots were found partially obstructing the ETT lumen once extubated postmortem. Evidence of aspiration was detected at postmortem examination, which also identified pulmonary haemorrhage.
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Chung MY, Jeong HD, Kim SG, Kim CJ. Hemoptysis during general anesthesia in a diabetic patient with healed tuberculosis: a case report. Korean J Anesthesiol 2017; 70:86-89. [PMID: 28184273 PMCID: PMC5296394 DOI: 10.4097/kjae.2017.70.1.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
Hemoptysis is a common complication of pulmonary tuberculosis. Most of the cases of hemoptysis originate from hypertrophied bronchial arteries. Also, diabetes induces pulmonary vascular abnormalities such as endothelial dysfunction, inflammatory infiltration and pulmonary vascular remodeling. A 27-year-old male, with diabetes and a history of tuberculosis, underwent the procedure of pars plana vitrectomy under general anesthesia. After an uneventful intra-operative period, he had hemoptysis prior to extubation. Emergency fiberoptic bronchscopy showed blood plugs and spotted fresh blood at the right upper lobar bronchus. After successful embolization of the bronchial artery, the patient made a recovery and was discharged without experiencing any complication. Predisposing factors of hemoptysis in this case are presumed to be tuberculosis and diabetes. The bleeding might had been caused by the rupture of a weakened artery within the cavity in the right upper lobe, through expansion of the lung during manual ventilation by positive pressure.
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Affiliation(s)
- Mee Young Chung
- Department of Anesthesiology and Pain Medicine, St' Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Do Jeong
- Department of Anesthesiology and Pain Medicine, St' Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seul-Gi Kim
- Department of Anesthesiology and Pain Medicine, St' Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, St' Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Austin A, Modi A, Judson MA, Chopra A. Sevoflurane Induced Diffuse Alveolar Hemorrhage in a young patient. Respir Med Case Rep 2016; 20:14-15. [PMID: 27872805 PMCID: PMC5107734 DOI: 10.1016/j.rmcr.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022] Open
Abstract
We report a very rare case of Sevoflurane Induced Diffuse Alveolar Hemorrhage in a previously healthy young adult in the post-operative period following general anesthesia. Diffuse alveolar hemorrhage (DAH) associated with inhalation injury from halogenated gases is a unique entity in the literature that practicing clinicians should be cognizant of and considered in post-operative cases of acute respiratory distress whereby other etiologies have been excluded.
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Affiliation(s)
- Adam Austin
- Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Aakash Modi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Marc A Judson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Amit Chopra
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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