ards after laparoscopic adrenalectomy present by : r1 康庭瑞
TRANSCRIPT
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ARDS after laparoscopic adrenalectomy
Present by: R1康庭瑞
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Brief history• Name: 陸OO• Chart No.: 0623385• Gender: male• Age: 35 y/o• BH: ≒ 180 ㎝ • BW: 104 ㎏
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Brief history• NIDDM with OHA control for 10+ years• HTN for 8 years, poor control• Abdominal CT showed a small left adrenal tu
mor (15×14 ㎜ )• Primary aldosteronism (aldosterone-producin
g adrenal adenoma– Conn’s syndrome) was diagnosed
• Scheduled for laparoscopic adrenectomy on 4/1
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Brief history• Unfortunately, he suffered from dizzin
ess and nausea on 3/23, and he was sent to ER
• Hypertensive emergency (243/115 ㎜Hg) was impressed, and admitted for blood pressure control
• Arranged laparoscopic adrenectomy on 3/25 after hemodynamic stabilized
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Laboratory data• RBC 4.76×106/ ㎜ 3
• Hb 14.6g/dl• Hct 39.9%• PLT 256K/ ㎜ 3
• WBC 7590 ㎜ 3
• Seg 49.7%• Eos 7.5%• Baso 1.4%• Mono 6.7%• Lym 34.4%
• BUN 17.1mg/dl• Crea 1.23mg/dl• AST 19U/L• ALT 32U/L• Na 137.1mEq/L• K 3.28mEq/L• Cl 102mEq/L• CRP 0.15ug/dl• Tpn-I 0.1ng/ml
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ECG
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Chest X-ray (3/23)
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Induction • High airway pressure after intubation• Breathing sound decreased and whee
zing over right lung field• Initial blood gas after the setting of A-l
ine: 麻單1,CVP insertion• Changed to 8.0 endotracheal tube usi
ng tube exchanger smoothly after NG suction
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Peri-operation• Airway pressure still high during the o
peration• Position of the patient: right side later
al decubitus, head and leg-down tilt• NG tube did not free drainage to deco
mpression • End-tidal CO2: 麻單2• SPO2 gradually decreased
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Post-operation• Returned to spontaneous breathing b
ut small tidal volume• Chest wall paradoxical movement• Breathing sound: bilateral rales and w
heezing• SPO2: gradually decreased to 75%• ABG: PaO2 dropped to 47.6 ㎜ Hg, resp
iratory acidosis
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Postoperative chest X-ray (3/25)
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Chest X-ray (3/25 6pm)
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Chest X-ray (3/26)
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Chest X-ray (3/27)
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Chest X-ray (3/28)