BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations.Negative pressure in the lungs is created,resu...BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations.Negative pressure in the lungs is created,resulting in negative pressure pulmonary edema(NPPE).CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression.The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier.We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery.Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors,anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur,anesthesiologists should take care not to induce airway irritation.展开更多
BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine out...BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.展开更多
文摘BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations.Negative pressure in the lungs is created,resulting in negative pressure pulmonary edema(NPPE).CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression.The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier.We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery.Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors,anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur,anesthesiologists should take care not to induce airway irritation.
文摘BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.
