Anesth Pain Med.  2023 Oct;18(4):439-444. 10.17085/apm.23085.

Severe pulmonary edema occurred during endobronchial ultrasound under monitored anesthesia care - A case report -

• Choi HY
• Kang HK
• Heo MH
• Lee SI
• Kim JY
• Kim KT
• Park JS
• Choe WJ
• Kim KW
• Kim JH

• KMID: 2550925
• DOI: http://doi.org/10.17085/apm.23085

Abstract

Background
Endobronchial ultrasound (EBUS) is widely used to diagnose lung cancer. Monitored anesthesia care (MAC) can enhance patient comfort and procedural conditions during EBUS. EBUS under MAC is usually safe but can lead to various complications. Case: A 34-year-old male who had increased sputum for two months showed an enlarged paratracheal lymph node and planned for lymph node biopsy by EBUS. During EBUS under MAC, an unexpected oxygen saturation decline required intervention. After intubation, copious frothy fluid was suctioned from the bronchi, and oxygenation was recovered. A narrowed trachea and the EBUS bronchoscope might have resulted in upper airway obstruction, and suction performed under these conditions might have caused pulmonary edema. The patient received non-invasive ventilation and high-flow nasal cannula and recovered without complications. Conclusions: When there is an expected risk of upper airway obstruction during EBUS, careful preoperative evaluation and preparation are essential to prevent negative pressure pulmonary edema.

Keyword

Airway obstruction; Bronchoscopes; Deep sedation; Lymph nodes; Pulmonary edema; Suction; Trachea; Ventilation

Figure

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  Fig. 1. Chest computed tomography. The diameter of the trachea is decreased due to an enlarged right paratracheal lymph node. Red arrow: enlarged lymph node, White arrow: narrowed trachea (internal diameter 7.3 mm).

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  Fig. 2. Bronchoscopy view after intubation, there are many bubbles in the entire bronchus.

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  Fig. 3. Chest radiography. (A) Pre-procedure: right paratracheal opacity, (B) post-procedure: multifocal ground-glass and nodular opacity are scattered in both lung fields, suggesting pulmonary edema.

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