ARDS after laparoscopic adrenalectomy

Present by： R1康庭瑞

Brief history• Name: 陸ＯＯ• Chart No.: 0623385• Gender: male• Age: 35 y/o• BH: ≒ 180 ㎝ • BW: 104 ㎏

Brief history• NIDDM with OHA control for 10+ years• HTN for 8 years, poor control• Abdominal CT showed a small left adrenal tu

mor (15×14 ㎜ )• Primary aldosteronism (aldosterone-producin

g adrenal adenoma– Conn’s syndrome) was diagnosed

• Scheduled for laparoscopic adrenectomy on 4/1

Brief history• Unfortunately, he suffered from dizzin

ess and nausea on 3/23, and he was sent to ER

• Hypertensive emergency (243/115 ㎜Hg) was impressed, and admitted for blood pressure control

• Arranged laparoscopic adrenectomy on 3/25 after hemodynamic stabilized

Laboratory data• RBC 4.76×106/ ㎜ 3

• Hb 14.6g/dl• Hct 39.9%• PLT 256K/ ㎜ 3

• WBC 7590 ㎜ 3

• Seg 49.7%• Eos 7.5%• Baso 1.4%• Mono 6.7%• Lym 34.4%

• BUN 17.1mg/dl• Crea 1.23mg/dl• AST 19U/L• ALT 32U/L• Na 137.1mEq/L• K 3.28mEq/L• Cl 102mEq/L• CRP 0.15ug/dl• Tpn-I 0.1ng/ml

ECG

Chest X-ray (3/23)

Induction • High airway pressure after intubation• Breathing sound decreased and whee

zing over right lung field• Initial blood gas after the setting of A-l

ine: 麻單1,CVP insertion• Changed to 8.0 endotracheal tube usi

ng tube exchanger smoothly after NG suction

Peri-operation• Airway pressure still high during the o

peration• Position of the patient: right side later

al decubitus, head and leg-down tilt• NG tube did not free drainage to deco

mpression • End-tidal CO2: 麻單2• SPO2 gradually decreased

Post-operation• Returned to spontaneous breathing b

ut small tidal volume• Chest wall paradoxical movement• Breathing sound: bilateral rales and w

heezing• SPO2: gradually decreased to 75%• ABG: PaO2 dropped to 47.6 ㎜ Hg, resp

iratory acidosis

Postoperative chest X-ray (3/25)

Chest X-ray (3/25 6pm)

Chest X-ray (3/26)

Chest X-ray (3/27)

Chest X-ray (3/28)