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• W2997430897 abstract "Se presenta el caso de un varón de 56 años de edad con antecedente de carcinoma escamocelular de pene llevado a cirugía electiva de penectomía parcial con remodelación. Antecedentes destacables con hipotiroidismo clínico secundario y dislipidemia, sin historial médico de alergias, ni tampoco cirugías previas. El transoperatorio transcurre sin complicaciones. Durante el procedimiento se administra fentanil, bupivacaína y midazolam intravenosos, sin complicaciones. En el postoperatorio inmediato, y después de la administrar 0,2 mg de naloxona en dosis única, el paciente presenta insuficiencia respiratoria mixta, taquicardia y taquipnea con posterior bradicardia severa; evoluciona a choque distributivo con requerimiento de soporte vasopresor y soporte ventilatorio mecánico. Se realiza radiografía de tórax y fibrobroncoscopia con hallazgos sugestivos de edema pulmonar no cardiogénico, y sangrado generalizado a nivel del árbol bronquial en divisiones lobares, segmentarias y subsegmentarias de manera bilateral, respectivamente. Perfil autoinmune normal, índice de hemosiderófagos de lavado bronquioloalveolar del 7%, enzimas cardiacas negativas, no cambios electrocardiográficos, el ecocardiograma transtorácico muestra hipertensión pulmonar moderada con sobrecarga leve del ventrículo derecho. Posterior al manejo con soporte vasopresor y ventilatorio hay resolución exitosa del edema pulmonar, confirmado por radiografía de tórax, un mes posterior a su hospitalización. De manera retrospectiva se aplicó la escala de Naranjo con un puntaje de 5, sugestivo de una relación probable del evento con el fármaco en cuestión. Aunque la naloxona se considera un medicamento seguro con pocas complicaciones, las indicaciones de su uso deben ser precisas y bien documentadas, ya que pueden presentarse las complicaciones severas como el edema pulmonar no cardiogénico. The case is presented of a 56 year-old man with a history of squamous cell carcinoma of the penis, who underwent elective surgery of partial penectomy with remodelling. He had a clinical history of secondary clinical hypothyroidism and dyslipidaemia, with no medical history of allergies, or previous surgeries. There were no complications during the partial penectomy surgery. During the procedure intravenous fentanyl, bupivacaine, and midazolam were administered without complications. In the immediate postoperative period and after administering naloxone 0.2 mg, the patient had a mixed respiratory failure, tachycardia, tachypnoea, and then severe bradycardia that progressed to distributive shock, requiring vasopressor and mechanical ventilatory support. Chest radiography and fibrobronchoscopy were performed with findings suggestive of non-cardiogenic pulmonary oedema and generalised bleeding at bronchial tree, lobar, segmental and sub-segmental divisions bilaterally, respectively. The autoimmune profile, the haemosiderophage index of 7% in the bronchioloalveolar lavage, and cardiac enzymes were normal. There were no changes in the electrocardiograph, but the transthoracic ultrasound showed moderate pulmonary hypertension with mild overload of the right ventricle. After management with vasopressors and ventilatory support, there was a successful resolution of the pulmonary oedema, confirmed by chest radiography one month after admission. The Naranjo scale was applied retrospectively, with a score of 5 that suggested a probable relationship of the event with the drug in question. Although naloxone is considered a safe drug with few complications, the indications have to be precise and well documented, since severe complications with non-cardiogenic pulmonary oedema may occur." @default.
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• W2997430897 date "2020-01-01" @default.
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• W2997430897 title "Edema pulmonar no cardiogénico secundario al uso de naloxona. Reporte de caso" @default.
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• W2997430897 doi "https://doi.org/10.1016/j.acci.2019.11.003" @default.
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