Postoperatif Sevoflurana Bağlı Diffüz Alveolar Hemoraji Gelişen Olgunun Yoğun Bakım Yönetimi
Özet
Genel anestezi esnasında kullanılan inhalasyon anesteziği sevoflurana bağlı postoperatif diffüz alveolar hemoraji gelişen bir olgunun sunulması amaçlandı. Septoplasti yapılan 31 yaşında erkek hasta intravenöz % 1 propofol, rokuronyum, fentanil ve inhale sevofluran ile komplikasyonsuz cerrahi uygulandı. Ameliyat sonunda hipoksemi, dispne ve hemoptizi tespit edildi. Akciğer grafisinde bilateral yaygın alveolar infiltratlar görüldü. Bilgisayarlı toraks tomografi (BT) görüntülemesinde, bilateral akciğerlerde yamalı konsolidasyon ve buzlu cam opasiteleri mevcuttu. Sedasyon altında yapılan bronkoskopide yaygın eritematöz alanlar ve aktif kanama gözlendi. Bakteriyel, mikobakteriyel ve fungal kültürleri ve sitolojide de HIV ve viral hepatit için yapılan serolojik testler negatif çıktı. Tedavide üç gün boyunca (1 g gün-1 metil prednizolon) steroid tedavisi uygulandı. Tedavi sonrası hemoptizi azalarak kesildi ve tekrar atak görülmedi.
We aimed to report a case of postoperative diffuse alveolar hemorrhage due to inhaled sevoflurane used during general anesthesia. A 31-year-old male patient who underwent septoplasty underwent uncomplicated surgery with intravenous 1% propofol, rocuronium, fentanyl and inhaled sevoflurane. Hypoxemia, dyspnea and hemoptysis were detected at the end of surgery. Chest radiography showed bilateral diffuse alveolar infiltrates. Computed thorax tomography (CT) imaging showed patchy consolidation and ground glass opacities in bilateral lungs. Bronchoscopy performed under sedation showed diffuse erythematous areas and active bleeding. Bacterial, mycobacterial and fungal cultures and serologic tests for HIV and viral hepatitis on cytology were negative. Steroid therapy (1 g day-1 methyl prednisolone) was administered for three days. After the treatment, hemoptysis decreased and stopped and there was no recurrence of the attack.
Referanslar
Miller AL, Theodore D, Widrich J. Inhalational Anesthetic. 2022. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32119427.
Cengiz O, Kivrak A, Yegen M, Demir M. Sevoflurane induced diffuse alveolar haemorrhage in a young patient after orthopedic surgery: A case report. Niger J Clin Pract. 2020; 23:120-122.
Yasli SO, Dogruel F, Demirbas AE, Canpolat DG. A case of diffuse alveolar hemorrhage after orthognathic surgery: Case report with the literature review. Niger J Clin Pract. 2022 ;25(6):967-970.
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.
Gentz BA, Malan TP Jr. Renal toxicity with sevoflurane: a storm in a teacup? Drugs. 2001;61(15):2155-62.
Fatheree RS, Leighton BL. Acute respiratory distress syndrome after an exothermic Baralyme-sevoflurane reaction. Anesthesiology. 2004;101(2):531-533.
Dogan IV, Ovali E, Eti Z, et al. The in vitro effects of isoflurane, sevoflurane, and propofol on platelet aggregation. Anesth Analg.1999;88(2):432–6.
Fatheree RS, Leighton BL. Acute respiratory distress syndrome after an exothermic baralyme-sevoflurane reaction. Anesthesiology 2004; 101(2): 531-3.
Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest 2010; 137(5): 1164-71.
Mersh R, Ross C. Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced? BMJ Case Rep 2018; 2018:bcr2017222010.
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; 9:247-51.
