Celalettin KORKMAZ, Emin MADEN, Turgut TEKE, Rukiye METİNEREN, Kürşat UZUN

Unexplained acute respiratory distress syndrome after varicocele surgery; report of a case

Akut solunum sıkıntısı sendromu (ARDS) doğrudan ve dolaylı akciğer hasarını içeren birçok klinik bozuklukla ilişkili ani bir solunum yetmezliği sendromudur. Vasküler cerrahi geçiren hastalar ARDS açısından risk altındadır. Yirmi üç yaşındaki erkek hasta epidural anestezi altında bir saat süren varikosel operasyonundan hemen sonra ani olarak gelişen nefes darlığı, siyanoz ve ajitasyon şikayetleriyle yoğun bakım ünitesine yatırıldı. Epidural anestezi için bupivakain, fentanil, remifentanil ve midazolam kullanılmıştı. Hastanın oksijen satürasyonu FiO2 0.5 iken %81 idi. Arteryel kan gazlarında hipoksemi ile birlikte respiratuar alkalozu vardı ve PaO2/FiO2 oranı 100 idi. Akciğer grafisinde bilateral alveoler opasiteler izlendi. Yatak başı yapılan ekokardiyografisinde sol ventrikül ejeksiyon fraksiyonu %65 ölçüldü. ARDS tanısı konularak hastaya noninvaziv mekanik ventilasyon (NIMV) tedavisi başlandı. Dördüncü günde NIMV tedavisi başarılı bir şekilde sonlandırılarak hasta taburcu edildi. Bu olgu sunumunda epidural anestezi altında varikosel operasyonundan hemen sonra gelişen, etyolojisi tam olarak izah edilemeyen ve NIMV ile başarılı bir şekilde tedavi edilen bir ARDS olgusu sunulmuştur.

Varikosel operasyonundan sonra gelişen ve etyolojisi izah edilemeyen bir akut solunum sıkıntısı sendromu olgusu

Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure that is associated with several clinical disorders including direct pulmonary injury and indirect pulmonary injury. Vascular surgical patients are at risk for ARDS. A 23-year old man was admitted to our respiratory intensive care unit with short of breath, cyanosis and agitation which was developed acutely after varicocele operation under epidural anesthesia lasted for one hour. Bupivacain, fentanyl, remifentadyl and midazolam were used for epidural anesthesia. Oxygen saturation was 81% while breathing oxygen at FiO2 of 0.5. Arterial blood gas analysis showed hypoxemia with respiratory alkalosis with a PaO2/FiO2 score of 100. A chest radiograph demonstrated bilateral alveolar opacities. Bedside echocardiography was performed which revealed no evidence of global hypokinesia, all the chambers were normal, left ventricular ejection fraction was 65%. A diagnosis of ARDS was made and the patient was initiated on noninvasive mechanical ventilation. He was gradually weaned off the NIMV and discharged after a total hospital stay of four days. We report an ARDS case due to unexplained etiology after varicocele operation under epidural anesthesia and managed successfully with noninvasive mechanical ventilation.

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