Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced?

BMJ Case Rep. 2018 Jul 10:2018:bcr2017222010. doi: 10.1136/bcr-2017-222010.

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.

Keywords: anaesthesia; mechanical ventilation; respiratory system.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anesthetics, Inhalation / adverse effects*
  • Echocardiography
  • Hemoptysis / etiology
  • Humans
  • Laryngeal Masks / adverse effects
  • Lung Diseases / etiology*
  • Lung Injury / diagnostic imaging
  • Lung Injury / etiology*
  • Male
  • Methyl Ethers / adverse effects*
  • Postoperative Hemorrhage / etiology*
  • Pressure / adverse effects*
  • Pulmonary Alveoli
  • Pulmonary Edema / etiology*
  • Sevoflurane
  • Tomography, X-Ray Computed

Substances

  • Anesthetics, Inhalation
  • Methyl Ethers
  • Sevoflurane