ARDS after laparoscopic adrenalectomy

1
ARDS after laparoscopic adrenalectomy

• Present byR1???

2
Brief history

• Name ?OO
• Chart No. 0623385
• Gender male
• Age 35 y/o
• BH ? 180?
• BW 104?

3
Brief history

• NIDDM with OHA control for 10 years
• HTN for 8 years, poor control
• Abdominal CT showed a small left adrenal tumor
  (1514?)
• Primary aldosteronism (aldosterone-producing
  adrenal adenoma Conns syndrome) was diagnosed
• Scheduled for laparoscopic adrenectomy on 4/1

4
Brief history

• Unfortunately, he suffered from dizziness 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

5
Laboratory data

• RBC 4.76106/?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

6
ECG
7
Chest X-ray (3/23)
8
Induction

• High airway pressure after intubation
• Breathing sound decreased and wheezing over right
  lung field
• Initial blood gas after the setting of
  A-line??1,CVP insertion
• Changed to 8.0 endotracheal tube using tube
  exchanger smoothly after NG suction

9
Peri-operation

• Airway pressure still high during the operation
• Position of the patient right side lateral
  decubitus, head and leg-down tilt
• NG tube did not free drainage to decompression
• End-tidal CO2??2
• SPO2 gradually decreased

10
Post-operation

• Returned to spontaneous breathing but small tidal
  volume
• Chest wall paradoxical movement
• Breathing sound bilateral rales and wheezing
• SPO2 gradually decreased to 75
• ABG PaO2 dropped to 47.6?Hg, respiratory acidosis

11
Postoperative chest X-ray (3/25)
12
Chest X-ray (3/25 6pm)
13
Chest X-ray (3/26)
14
Chest X-ray (3/27)
15
Chest X-ray (3/28)