| Anesthesia for an Acute Necrotizing Cholecystitis Patient with Pulmonary Edema. |
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Ki Bai Seo, In Bai Lee, Kun Jung Lee, Dong Ki Lee |
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Department of Anesthesiology, Seoul Red Cross Hosptial, Seoul, Korea. |
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| Abstract |
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A 46 year-old female patient underwent cholecystectomy under general anesthesia. During the preoperative preparation, pulmonary edema developed from fluid overloading in the early septic condition. Pulmonary edema contributed significantly to the acute respiratory failure, which played a major role in the pathogenesis of multiple organ failure.
For this condition, early surgical intervention is most important. After preoperative evaluaion, the authors anesthetized the patient with Morphine, used Enfluane intermitently, along with pancronium and oxygen and used endotracheal semiclosed circle absorption techniques with CMV incorporated PEEP. PEEP level was 5cm H2O. Inspired oxygen fraction was 1.0. Arterial oxygen tension increased from 62 torr to 183 torr despite the overt pulmonary edema.
A-aDO2 was greater than 480 mmHg during the anesthesia of 2 hrs 40 minutes. For further treatment of pulmonary edema and postoperative respiratory care, synchronized IMV with PEEP, along with conventional methods for pulmonary edema and sepsis, were used in the ICU. After 6 days of intensive care, the patient was transferred to the general ward in good cardiovascular and respiratory function. |
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