• Medicine · Feb 2019

    Case Reports

    Diffuse alveolar hemorrhage following sugammadex and remifentanil administration: A case report.

    • Won Kyu Choi, Jae Myeong Lee, Jong Bun Kim, Kyong Shil Im, Bong Hee Park, Su Bin Yoo, and Cha Yun Park.
    • Department of Anesthesiology and Pain Medicine.
    • Medicine (Baltimore). 2019 Feb 1; 98 (8): e14626.

    RationaleDiffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH.Patient ConcernsA 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia.DiagnosisChest x-ray and computed tomography showed DAH.InterventionsConservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid.OutcomesThe patient was discharged uneventfully.LessonsMuscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.

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