Pulmonary capillary leak associated with methylmethacrylate during general anesthesia. A case report

Noncardiogenic pulmonary edema (capillary leak syndrome) developed in a 61-year-old woman after methylmethacrylate was inserted for total hip replacement. The diagnosis was based on the low pulmonary artery and pulmonary artery wedge pressures, low systemic vascular resistance, relative hypovolemia, and clear pulmonary edema. The diagnosis of capillary leak syndrome can be confirmed by the finding of a protein composition of the pulmonary edema approximating that of plasma. The mechanism causing the capillary leak syndrome is unclear, but may be related to hypersensitivity, i.e., a previous hip arthroplasty, or to the release of vasoactive substances. Management consisted of fluid replacement to maintain cardiac output, and mechanical ventilation with positive end expiratory pressure to provide adequate oxygenation.