• Song Lyu and Min Liao.
• Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
• Medicine (Baltimore). 2024 Oct 11; 103 (41): e39857e39857.

RationaleManaging anesthesia in patients with severe pulmonary conditions involves complex considerations, especially when dealing with high baseline CO2 levels. We present a case that demonstrates the challenges and complexities of anesthesia and postoperative analgesia in a patient with severe pulmonary hypertension and a history of lung disease exacerbated by the interactions of protein-bound drugs.Patient ConcernsA 37-year-old woman at 38 weeks of gestation presented with recurrent chest tightness, shortness of breath, and worsening symptoms over a week, which required emergency medical attention.DiagnosisThe patient was diagnosed with severe pulmonary hypertension, and echocardiography revealed a pulmonary artery pressure of 106 mm Hg upon admission. Postoperative complications included sudden unconsciousness after low dose (2 µg) sufentanil administration, indicative of carbon dioxide narcosis that could compound pharmacological interactions and her underlying condition.InterventionsThe patient underwent a cesarean section under spinal anesthesia, which was complicated postoperatively by respiratory depression, requiring naloxone administration and intensive care.OutcomesDespite initial postoperative challenges, the patient's condition stabilized, allowing eventual discharge.LessonsThe clinical course highlighted the need for careful monitoring and prompt intervention in anesthesia in patients with severe pulmonary hypertension, particularly when administering multiple protein-bound drugs. Drug interactions can exacerbate the underlying condition, necessitating diligent oversight to prevent severe complications such as carbon dioxide narcosis.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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