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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：术后喉水肿可能是由于肾切除后拔管后引起急性气道阻塞的急性气道阻塞

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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：我们在此报告了在选修肾切除术后55年龄60公斤男性拔管后发生上气道阻塞的情况。用O 2（33％），N 2 O，七氟醚（1.5-2％）和异丙酚输注（2mg x Kg（-1）×HR（-1））保持麻醉。失血量为1,965毫升，其中一部分被输血和白蛋白输注取代。手术后，患者恢复不短，可以很快拔出。拔管后二十分钟，尽管使用氧气面膜和辅助通风，但他逐渐发展呼吸困难，并成为紫绀。氧饱和度逐渐降低，并且还观察到Bradycardia（<30次拍摄x min（-1））和严重的低血压。立即开始使用肾上腺素的心肺重新刺除。由于严重水肿，气管的重新插管难以使用较小尺寸（内径7.0mm）的管进行。随后使用纤维镜的调查证实了广泛的软组织肿胀，在声带水平和延伸到气管上的上下病，表明梗阻是由严重的喉部水肿引起的。我们认为，在运行结束时，水肿可能是由低恶蛋白酶（1.3g x dl（-1））引起的。因此，应该指出的是，低稳压血症可能导致喉部水肿导致急性气道阻塞。

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