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• W4387249923 abstract "SESSION TITLE: Drug Fiascos: Respiratory Compromise SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Sevoflurane is a commonly used inhaled halogenated anesthetic. Due to low solubility in blood and a better safety profile, it is used ubiquitously. We present a case of diffuse alveolar hemorrhage (DAH) induced by sevoflurane and provide a literature review of prior case reports. CASE PRESENTATION: A previously healthy 23-year-old man was admitted to the medical intensive care unit (ICU) following an elective ear keloid removal procedure due to blood noted within the endotracheal tube. His prior medical history was notable only for premature birth at 32 weeks necessitating neonatal intensive care, and early childhood pneumonias requiring hospitalization. He had no family history of cancer, cystic fibrosis, sarcoidosis, tuberculosis, or autoimmune diseases. He was in peak physical fitness currently employed as an Air Force mechanic. Social history did not reveal any international travel, exposure to chemical weapons, tobacco, cocaine, or vaping.The patient remained stable after post-operative monitoring and was subsequently extubated without event. His vital signs remained normal: Temperature 98.2F, Heart Rate 62 beats/min, Respirations 16/min, with saturations of 98% on ambient air. A comprehensive laboratory evaluation was unrevealing. A CT chest was obtained which showed a lobulated or nodular pattern of patchy pneumonia with pleural sparing as shown in figure 1. Bronchoscopy demonstrated significant blood in his airways bilaterally as shown in figure 2. Serial lavage from the right middle lobe showed progressive blood return as shown in figure 3. No upper airway trauma was noted. Extensive evaluation for autoimmune, infectious, coagulopathic, or other causes were negative. A diagnosis of diffuse alveolar hemorrhage due to sevoflurane was made. DISCUSSION: Of reported causes of DAH, drug and toxin exposure is rare comprising less than 10%.(1) Thorough history and exposures are key to reveal the underlying etiology. Sevoflurane is FDA approved inhaled halogenated anesthetic. Its adverse effects are mainly limited to cognitive development with repeated exposure.(2) Compared to other halogenated agents, major pulmonary complications of sevoflurane are rare. To our knowledge, this is the fourth case of sevoflurane-induced DAH.(3) Our patient was managed conservatively without any glucocorticoids or immunosuppressive therapy and is scheduled to have a follow-up with a repeat CT chest in 8 weeks. CONCLUSIONS: Clinicians should be made aware of this potentially under-reported adverse effect of a commonly used anesthetic medication. Reference #1: Collard HR, Schwarz MI. Diffuse alveolar hemorrhage. Clin Chest Med. 2004;25(3):583-592. doi:10.1016/J.CCM.2004.04.007 Reference #2: Apai C, Shah R, Tran K, Pandya Shah S. Anesthesia and the Developing Brain: A Review of Sevoflurane-induced Neurotoxicity in Pediatric Populations. Clin Ther. 2021;43(4):762-778. doi:10.1016/J.CLINTHERA.2021.01.024 Reference #3: Austin A, Modi A, Judson MA, Chopra A. Sevoflurane Induced Diffuse Alveolar Hemorrhage in a young patient. Respir Med Case Rep. 2017;20:14. doi:10.1016/J.RMCR.2016.11.001 DISCLOSURES: No relevant relationships by Ahad Azeem No relevant relationships by Alexander Staller" @default.
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• W4387249923 date "2023-10-01" @default.
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• W4387249923 title "INHALED ANESTHETIC-INDUCED DIFFUSE ALVEOLAR HEMORRHAGE" @default.
• W4387249923 doi "https://doi.org/10.1016/j.chest.2023.07.110" @default.
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