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Diffuse alveolar hemorrhage following sugammadex and remifentanil administration: A case report
Won Kyu Choi1, Jae Myeong Lee1, Jong Bun Kim1
1Department of Anesthesiology and Pain Medicine.
Rationale:
Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH.
Patient Concerns:
A 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia.
Diagnosis:
Chest x-ray and computed tomography showed DAH.
Interventions:
Conservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid.
Outcomes:
The patient was discharged uneventfully.
Lessons:
Muscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.
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