An acute postoperative intractable hyperventilation after an endoscopic third ventriculostomy.

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Respiratory Physiology

Background:

• Endoscopic third ventriculostomy (ETV) is a neurosurgical procedure for cerebrospinal fluid (CSF) diversion.
• Postoperative complications, though rare, require careful management and understanding.
• Hyperventilation can be a serious adverse event impacting patient stability.

Observation:

• A 46-year-old woman developed intractable hyperventilation (65 breaths/min, EtCO2 16.3 mm Hg) 60 minutes post-ETV.
• The hyperventilation persisted despite initial attempts at oxygenation via a rebreathing mask.
• Central neurogenic hyperventilation was suspected as the cause.

Findings:

• Aggressive sedative management, including benzodiazepines, thiopental sodium, fentanyl, and propofol/remifentanil infusions, was initiated.
• The patient's ventilation pattern gradually normalized over a 22-hour postoperative period.
• The suspected etiology involved stimulation of the central respiratory center by cold, acidic irrigation solution used during the procedure.

Implications:

• This case highlights a rare but significant postoperative complication following ETV.
• Effective management relies on prompt recognition and aggressive sedative therapy.
• Understanding potential iatrogenic causes, such as irrigation solution effects, is crucial for preventing recurrence.