Diffuse Alveolar Hemorrhage Induced by Sevoflurane

We present here a case of diffuse alveolar hemor-rhage (DAH) following exposure to inhaled anesthetic sevoflurane. A 29-year-old male was admitted to the plastic surgery department with gynecomastia. Sur-gery was performed without complication under gen-eral anesthesia with intravenously administered mid-azolam (4mg), fentanyl and inhaled sevoflurane. Immediate hypoxemia and massive hemorrhage was detected at the end of the operation, and a chest radiography revealed bilateral widespread alveolar infiltrates. The serum hemoglobin level dropped by 2.5 g/dl (from 13 to 10.5 gr) in the postoperative setting. The patient was treated with methylpredniso-lone (1 gr) administered intravenously daily for 3 days. The hypoxemia resolved and alveolar infiltrates on the chest radiograph disappeared on the 4th day. There is limited data in literature reporting on the association between sevoflurane and DAH. None of the predisposing factors or causative reasons for DAH were detected in our case, and so it can be conclud-ed that the use of sevoflurane as an inhaled anesthet-ic was responsible for the DAH.

Sevofluran ile Ýndüklenen Diffüz Alveolar Hemoraji

Ýnhale anestezik sevoflurana maruz kaldýktan sonra yaygýn alveolar hemoraji (DAH) geliþen bir olguyu sunmayý amaçladýk. Burada sunulan hasta, jineko-masti nedeniyle plastik cerrahiye baþvuran 29 yaþýnda bir erkek idi. Genel anestezi altýnda intravenöz mida-zolam (4mg), fentanil ve inhale sevofluran ile kompli-kasyonsuz cerrahi uygulandý. Ameliyat sonunda ani hipoksemi ve masif kanama tespit edildi. Akciðer grafisinde bilateral yaygýn alveolar infiltratlar görüldü. Ameliyat sonrasý dönemde serum hemoglobin düzeyi 2,5 g/dl (13'ten 10,5 gr'a) düþtü. Hastaya 3 gün süreyle intravenöz olarak günlük metilprednizolon (1 gr) tedavisi verildi. Dördüncü günde hipoksemi dü-zeldi ve akciðer grafisinde alveolar infiltratlar kaybol-du. Literatürdeki sýnýrlý veriler, sevofluran ve DAH arasýnda bir iliþki olduðunu göstermektedir. Bizim olgumuzda DAH' geliþimine neden olan sebepler ve zemin hazýrlayan faktörlerin hiçbiri saptanmadý. Bu nedenle, DAH'dan inhale anestezik olarak sevoflu-ran'ýn sorumlu olduðu düþünülmektedir.