ISSN : 1300-2945
eISSN : 1308-9889
Abstract - Anesthetic Approach For Major Vascular Injuries Requiring Cardiopulmonary Bypass In Mediastinoscopy
Mediha Türktan, Alper Avcı, Suat Gezer, Orhan Kemal Salih

Mediha Türktan, Çukurova Üniversitesi Tıp Fakültesi, Anesteziyoloji Ana Bilim Dalı, Adana, Türkiye e-mail: mediturktan@gmail.com

 

Abstract

Aim: Negative pressure pulmonary edema (NPPE) is a rare postoperative complication that arises due to upper airway obstruction and appears within an hour of extubation.

Case: The patient was a 19 years-old male with no chronic diseases or complaints in his preoperative assessment. Forty-five minutes after extubation, the patient reported dyspnea, hemoptysis, chest pain and oxygen saturation was 60%. Computer Tomography (CT) scans revealed bilateral infiltration and consolidation, more prominent in the central and apical regions. His bedside echocardiogram was normal. NPPE was considered in the diagnosis; oxygen support, intravenous furosemide, nebulized salbutamol and budosenide were administered in addition to non-invasive mechanical ventilation. Two hours later, the symptoms abated. His repeat X-ray taken after 12 hours showed reduction in lung infiltrates and patient was discharged after five days.

Conclusion: Abrupt decrease in oxygen saturation after extubation, dyspnea, chest pain and hemoptysis point to negative pressure pulmonary edema; the patient must immediately be moved to the intensive care unit and promptly treated.

Keyword: Hemoptysis, pulmonary edema, mechanical ventilation.

 

Mediastinoskopi Girişimlerinde Kardiyopulmoner Bypass Gerektiren Damar Yaralanmalarında Anestezik Yaklaşım                   

Öz

Mediastinoskopi; mediastinal lenf noduevrelemesi için gelişmiş görüntüleme yöntemlerine karşın (transtorasik iğne aspirasyonu, torakoskopik biyopsi, endoskopik ince iğne aspirasyonu gibi) halen altın standart olmaya devam etmektedir. Genellikle güvenli bir işlem olmasına rağmen, pnömotoraks, sol rekürren sinir hasarı, trakeal ya da özefagialrüptür ve büyük damar yaralanması nadir görülen ancak korkulan komplikasyonlardır.

Mortaliteye sebep olan en önemli komplikasyonu ise major kanamadır. Bu olgu sunumunda mediastinoskopi sırasında ciddi kanama gelişen ve kardiyopulmoner bypass altında onarım yapılan iki olgunun anestezik yaklaşımı tartışılmıştır.

Anahtar kelimeler: Damar yaralanması, kardiyopulmoner bypass, mediastinoskopi, anestezi      

Dicle Med J  2019;46 (3): 587-591

Doi: 10.5798/dicletip.620646

 

Volume 46, Number 3 (2019)