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首页> 外文期刊>麻酔 >Postoperative laryngeal edema presumably due to hypoalbuminemia causing acute airway obstruction after extubation in a patient after nephrectomy
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Postoperative laryngeal edema presumably due to hypoalbuminemia causing acute airway obstruction after extubation in a patient after nephrectomy

机译：肾切除术后患者的拔管后低白蛋白血症可能导致术后呼吸道阻塞，可能是喉后水肿

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摘要

We report here a case of upper airway obstruction occurring after extubation in a 55-yr-old 60 kg man after elective nephrectomy. Anesthesia was maintained with O2 (33%), N2O, sevoflurane (1.5-2%), and propofol infusion (2 mg x kg(-1) x hr(-1)). Blood loss was 1,965 ml, part of which was substituted by blood transfusion and albumin infusion. After surgery, the patient recovered uneventfully and could be extubated shortly. Twenty minutes after extubation, he developed dyspnea progressively with stridor and became cyanotic despite the use of oxygen mask and assisted ventilation. Oxygen saturation decreased gradually, and bradycardia (<30 beats x min(-1)) and severe hypotension were also observed. Cardiopulmonary resuscitation using epinephrine was immediately started. Re-intubation of the trachea was difficult due to severe edema, but eventually performed using a tube of a smaller size (internal diameter 7.0 mm). Subsequent investigations using a fiberscope confirmed extensive soft tissue swelling, maximal at the level of the vocal cord and extending up- and down-wards to the trachea, indicating that the obstruction is caused by severe laryngeal edema. We believe that edema may have been caused by hypoalbuminemia (1.3 g x dl(-1)) at the end of operation. Therefore, it should be noted that hypoalbuminemia may cause laryngeal edema leading to acute airway obstruction.
机译：我们在这里报告一例选择性肾切除术后55岁60公斤男性拔管后发生上呼吸道阻塞的情况。用O2（33％），N2O，七氟醚（1.5-2％）和异丙酚输注（2 mg x kg（-1）x hr（-1））维持麻醉。失血量为1,965毫升，部分被输血和白蛋白输注代替。手术后，患者恢复平稳，可以短期拔管。拔管后20分钟，尽管使用了氧气面罩和辅助通气，他仍逐渐出现喘鸣性呼吸困难，并发。氧饱和度逐渐降低，并且还观察到心动过缓（<30次搏动x min（-1））和严重的低血压。立即开始使用肾上腺素进行心肺复苏术。由于严重的水肿，气管难以再次插管，但最终使用较小尺寸的管（内径7.0 mm）进行。随后使用纤维镜进行的研究证实，广泛的软组织肿胀，在声带水平最大，并向上和向下延伸至气管，表明阻塞是由严重的喉头水肿引起的。我们认为在手术结束时水肿可能是由低白蛋白血症（1.3 g x dl（-1））引起的。因此，应注意的是，低白蛋白血症可能引起喉头水肿，导致急性气道阻塞。

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