A Case of Pulmonary Edema Developed during Cesarean Section in a Patient with Servere Preeclapmsia / 대한마취과학회지

ABSTRACT

Preeclampsia continues to represent a significant cause of morbidity and mortality in 5-10% of all pregnancies. The pathophysiology of preeclampsia can involve virtually every organ system, and in extreme cases cardiac decompensation may occur. Single epidural anesthesia for Cesarean section was performed in a patient with severe preeclampsia who already had clinical evidence of pulmonary congestion. A balanced salt solution was administered rapidly to prevent hypotension resulting from the epidural block. She started complaining of severe dizziness around 10 minutes after epidural injection of 18 ml bupivacaine. General anesthesia was substituted for epidural anesthesia because of inadequate analgesia for the operation. Chest rales and frothy sputum through the endotracheal tube were noticed to the patient and she remained unconscious after the operaion was finished. The chest X-ray revealed pulmonary edema but the brain computed tomographic scan was unremarkable. She was treated in the intensive care unit using a respirator with PEEP therapy and vasodilators. She was rapidly recovered from unconsciousness with cardiovascular instability. It was suggested that rapid hydration was one of the main contributing factors causing pulomanary edema in this patient with severe preeclampsia. The pulmonary edema possibly could be prevented by monitoring of pulmonary capillary wedge pressure with careful Swan-Ganze catheterization.