Unusual case of intraoperative acute cor pulmonale during spine surgery

Perioperative complications of prolonged surgery and prone positioning are well known. Changing the position from prone to supine in an anesthetized patient can result in aspiration and airway obstruction. The drop-in oxygen saturation and hemodynamic changes are warning signs and can cause acute cardiac decompensation leading to diagnostic dilemma. We present a case where the patient had these changes after changing the position after spine surgery in prone position. A quick response from the treating anesthesiologist and active involvement of cardiologist helped in reaching the diagnosis and successful management of aspiration pneumonitis in this patient. We conclude that a quick response in investigations and multimodality approach helps in the management of such perioperative complications.

Aspiration pneumonitis in achalasia patient treated by per oral endoscopic myotomy: A case report

Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired lower esophagus sphincter relaxation. The exact etiology remains unclear. Stasis of ingested food in esophagus lead to clinical symptoms such as dysphagia, regurgitation, retrosternal pain and weight loss. We report a case of regurgitation during general anesthesia in thyroid cancer patient with achalasia of esophagus. Despite having per oral endoscopic myotomy 6 months ago, the patient presented regurgitation and aspiration pneumonitis. The patient recovered after a week of antibiotics therapy.

Massive Diffuse Alveolar Hemorrhage Caused by the Aspiration of Gastric Contents during Induction of Anesthesia in Patients with Adhesive Ileus: A Case Report / 대한구급학회지

Aspiration pneumonitis is best defined as an acute lung injury, following the aspiration of regurgitated gastric contents. Major cause of pulmonary aspiration, during anesthesia, is gastric contents. Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS). However, there was no report of massive alveolar hemorrhage associated with aspiration pneumonitis. A 63-year-old man, who had undergone a total gastrectomy and received adjuvant chemotherapy, four months ago, was scheduled for adhesiolysis of the small bowel. The patient occurred aspiration of gastric contents, during induction of anesthesia, and subsequently, hypoxia developed during surgery. The patient moved to an intensive care unit (ICU), without extubation. Mechanical ventilation with PEEP was performed in an ICU. However, the patient died by ARDS and massive alveolar hemorrhage.

Aspiration pneumonitis after a 10-hour fast in a patient who had undergone subtotal gastrectomy: A case report / 대한마취과학회지

A patient who had previously undergone a subtotal gastrectomy was scheduled for removal of a brain tumor under general anesthesia. Anesthesia was induced with lidocaine and propofol with rocuronium for neuromuscular blockade. She had fasted for 10 hours, but after mask ventilation, she aspirated gastric juice and materials. The oral cavity was suctioned promptly and the trachea was intubated. Intraoperative high FiO2 and dopamine were administrated to maintain the oxygen saturation and blood pressure. She received postoperative ventilatory care in the intensive care unit for 2 weeks. An upper gastrointestinal series and fiber endoscopy were performed but she had no obstruction and reflux esophagitis except delayed passage of the contrast media. She had no risk factors for pulmonary aspiration. As in this case, patients with previous gastrointestinal surgery should be considered preoperative workup for GI motility or pathology, and adequate premedication.

The Effects of Preoperative Vaginal Misoprostol on Gastric Contents / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the effect of vaginal misoprostol for operative hysteroscopy on preoperative gastric contents and the risk of acid aspiration pneumonitis. METHODS: Sixty-five patients undergoing operative hysteroscopy who received prophylactic vaginal misoprostol 200 microgram were assigned to the misoprostol group, and sixty-five gynecologic patients without premedication were assigned to the control group. After preoxygenation, a 14-F multiorifice nasogastric tube was inserted for direct aspiration under target-controlled propofol sedation. RESULTS: The mean pH value of gastric fluid was significantly higher in the misoprostol group (2.7 +/- 1.0) than the control group (1.9 +/- 0.7). The mean aspirated volume was (ml) 15.3 +/- 7.4 in the misoprostol group and 16.8 +/- 6.9 in the control group (P > 0.05). There were significantly less patients at high-risk (gastric fluid volumes > 25 ml and pH < 2.5) in the misoprostol group (8/65, 12.3%) than in the control group (18/65, 27.7%). Prophylactic vaginal misoprostol increases the preoperative gastric pH and reduces the number of at high-risk of acid aspiration pneumonitis. CONCLUSIONS: Therefore, vaginal misoprostol for outpatient hysteroscopy may have preventive effect on the acid aspiration pneumonitis.

Aspiration Pneumonitis Occurring during General Anesthesia in a Parturient with Strangulation Ileus: A case report / 대한마취과학회지

Pulmonary aspiration of gastric contents is the main cause of anesthesia-related maternal deaths. We experienced a case of pulmonary aspiration during induction of general anesthesia for an emergency cesarean section. The parturient was admitted for severe abdominal pain and abnormal fetal movement. She had no remarkable past medical history except for an appendectomy, 3 years earlier. The massive pulmonary aspiration of acid-liquid, malodorous feculent, gastric contents occurred accidently. Immediate endotracheal intubation and suction were followed. The strangulation ileus of the small bowel resulting from the pressure of the enlarged uterus on intestinal adhesions was detected after cesarean delivery and severe pulmonary edema developed during the perioperative period. Intensive care including mechanical ventilation with positive end-expiratory pressure, frequent suction, antibiotic therapy and other measures was attempted. At the 50th day after the operation the patient was discharged fortunately without any meaningful pulmonary sequelae. In conclusion, we should be aware of the possibility of mechanical ileus and pulmonary aspiration in parturients with past abdominal operation histories during anesthesia for cesarean section.