뇌병변 장애 소아 전신마취 종료 후 기관내관 발관 뒤 발생한 폐부종
Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
A 9-year-old child with cerebral palsy developed negative-pressure pulmonary edema (NPPE) followed by upper airway obstruction, which may be attributable to laryngospasm during recovery from general anesthesia. Therefore, the patient underwent repeat endotracheal intubation and was transferred to the intensive care unit. Mechanical ventilation and positive-pressure end-expiratory pressure led to resolution of pulmonary edema. The endotracheal tube was removed 1 day postoperatively, and the patient was discharged without sequelae. NPPE is rare in children and self-limited; however, delayed diagnosis and lack of appropriate treatment may be fatal. Notably, administration of general anesthesia to patients with cerebral palsy is associated with difficulty in airway intubation, decreased ventilatory function, aspiration of gastric contents, slow recovery from anesthesia, and anesthesia-induced adverse effects. Therefore, careful anesthesia management is warranted in children with cerebral palsy. In this case report, we describe the essential precautions during administration of general anesthesia to children with cerebral palsy and the pathophysiology, diagnosis, and treatment of NPPE, together with a literature review.
Abstract
A 9-year-old child with cerebral palsy developed negative-pressure pulmonary edema (NPPE) followed by upper airway obstruction, which may be attributable to laryngospasm during recovery from general anesthesia. Therefore, the patient underwent repeat endotracheal intubation and was transferred to the intensive care unit. Mechanical ventilation and positive-pressure end-expiratory pressure led to resolution of pulmonary edema. The endotracheal tube was removed 1 day postoperatively, and the patient was discharged without sequelae. NPPE is rare in children and self-limited; however, delayed diagnosis and lack of appropriate treatment may be fatal. Notably, administration of general anesthesia to patients with cerebral palsy is associated with difficulty in airway intubation, decreased ventilatory function, aspiration of gastric contents, slow recovery from anesthesia, and anesthesia-induced adverse effects. Therefore, careful anesthesia management is warranted in children with cerebral palsy. In this case report, we describe the essential precautions during administration of general anesthesia to children with cerebral palsy and the pathophysiology, diagnosis, and treatment of NPPE, together with a literature review.
참고문헌 (15)
- Mevorach DL, "The management and treatment of recurrent postoperative laryngospasm", Anesth Analg, 83, pp.1110~1111 (1996)
- Alalami AA, "Laryngospasm : review of different prevention and treatment modalities", Pediatr Anesth, 18, pp.281~288 (2008)
- Lang SA, "Pulmonary oedema associated with airway obstruction", Can J Anaesth, 37, pp.210~218 (1990)
- Nam OH, "Traumatized tooth stabilization using vacuum-formed splint in a cerebral palsy patient", Korean Assoc Disabil Oral Health, 10, pp.89~92 (2014)
- Jeong JY, "Anesthetic management for a patient with total body cerebral palsy : a case report", Korean J Anesthesiol, 36, pp.553~557 (1999)
- Udeshi A, "Postobstructive pulmonary edema", J Crit Care, 25, pp.508~ (2010)[DOI]
- Silva PS, "Negative-pressure pulmonary edema : a rare complication of upper airway obstruction in children", Pediatr Emerg Care, 21, pp.751~754 (2005)
- Galvis AG, "Pulmonary edema complicating relief of upper airway obstruction", Am J Emerg Med, 5, pp.294~297 (1987)
- Taha S, "Complicated negative pressure pulmonary oedema in a child with cerebral palsy", Pediatr Anesth, 12, pp.181~186 (2002)
- 민수영, "뇌성마비 환자에서 전신마취 후 나타난 호흡곤란 -증례보고-", Journal of Dental Anesthesia and Pain Medicine, 11(1), pp.55~60 (2011), 대한치과마취과학회
- Davidson S, "Diagnosis and treatment of negative pressure pulmonary edema in a pediatric patient : a case report", AANA J, 72, pp.337~338 (2004)
- 나윤숙, "발관 후 발생한 음압성 폐부종(2예)과 폐출혈(1예)-증례 보고-", Acute and Critical Care, 25(2), pp.98~103 (2010), 대한중환자의학회
- Jain R, "Negative pressure pulmonary oedema following use of ProSeal LMA", Indian J Anaesth, 57, pp.188~190 (2013)
- Chuang YC, "Negative pressure pulmonary edema : report of three cases and review of the literature", Eur Arch Otorhinolaryngol, 264, pp.1113~1116 (2007)
- Lee KT, "Pulmonary edema secondary to laryngospasm in children", Anesthesiology, 59, pp.347~349 (1983)