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Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
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[A case of pulmonary edema due to excess absorption of perfusion fluid during transcervical resection using saline

Norikazu Takada1, Ayaka Fujita, Hiroshi Hashimoto

  • 1Department of Anesthesiology, Hirosaki University Hospital, Hirosaki 036-8563.

Masui. the Japanese Journal of Anesthesiology
|August 19, 2010
PubMed

A 39-year-old woman underwent transcervical resection (TCR) of submucosal uterus myoma. Induction and maintenance of anesthesia were managed with total intravenous anesthesia using propofol, remifentanil and rocuronium bromide. Patient had stable condition from the anesthesia induction until 75 minutes following skin incision. However, around that period, sudden tidal volume reduction, worsening oxygenation, and head and neck swelling developed. Arterial blood gas analysis indicated high-chloride metabolic acidosis. Transesophageal echocardiography showed excess right heart overload. On arriving at ICU, body weight of the patient increased about 10 kg compared to the preoperative value. Artificial ventilation and diuretics administration were done to treat excess body fluid. And the patient recovered without any subsequent complications. It should be noted that in case of TCR, unpredicted excess fluid load could develop, and careful observation and management are required by anesthesiologist in charge.

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