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복강경하 부신경절종 제거술 중 발생한 일측성 미만성 폐포내출혈: 증례보고

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Author(s)
김상백김지섭박지훈
Alternative Author(s)
Kim, Ji SeobPark, Ji Hoon
Publication Year
2020
Keyword
Bronchial spasmDiffuse alveolar hemorrhageHypertensionParaganglioma
Abstract
Diffuse alveolar hemorrhage is life-threatening situation which is rarely caused by paraganglioma or pheochromocytoma. Here, we describe anesthetic management of 64-year-old man underwent laparoscopic pararenal mass excision and later on this mass diagnosed as paraganglioma. We induced anesthesia with propofol 120 mg, sufentanil 12.5 µg, and rocuronium 50 mg. Anesthesia was maintained with sevoflurane administration. Patient position was changed to right lateral decubitus position for laparoscopic approach. Vital signs were stable until direct stimulation of mass. When surgeon started to manipulate pararenal mass, blood pressure suddenly increased to 274/169 mmHg and heart rate also increased to 140 beat/minute. SpO2 dropped to 69% and bilateral lung sounds decreased. We used intravenous esmolol to control blood pressure and heart rate. In doubt for bronchial spasm, we used intravenous hydrocortisol and chlorpheniramine maleate. Discharge of bloody fluid was obtained from endotracheal tube. Immediate postoperative chest x-ray showed diffuse air space consolidation in right lung field. We assessed as unilateral alveolar hemorrhage and patient was transferred to intensive care unit (ICU) without endotracheal extubation. The patient was followed up with ventilator care and antibiotic treatment in ICU, and daily chest x-ray was taken. He was extubated after showing favorable prognosis on postoperative day (POD) 4, and discharged on POD 7. Anesthesiologist should be aware that incidental manipulation of undiagnosed catecholamine producing tumor can lead to fatal consequences, and should know the management of hypertensive crisis and bronchial spasm.
Department
Dept. of Anesthesiology & Pain Medicine (마취통증의학)
Citation
김상백. (2020). 복강경하 부신경절종 제거술 중 발생한 일측성 미만성 폐포내출혈: 증례보고. Keimyung Medical Journal, 39(1), 52-56. doi: 10.46308/kmj.2020.00087
Type
Jounral
DOI
10.46308/kmj.2020.00087
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/42808
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