Abstract
This is a case of a 28-yr-old man who underwent general anaesthesia for emergency repair of a right lid laceration and lacrimal apparatus. Following induction of anaesthesia and local nasal application of phenylephrine (0.25%) he developed transient elevation of blood pressure, which was treated immediately with labetalol. Subsequently the patient developed acute pulmonary oedema which responded to treatment with morphine and furosemide. The diagnosis of pulmonary oedema was confirmed by blood gas studies, chest x-ray and serial echocardiograms. Subsequent investigation revealed that he was a cocaine user, as the urine tested positive for cocaine. Considering that the patient was young and otherwise healthy and that the hypertension was transient, it is unlikely that phenylephrine was the main cause of pulmonary oedema. Cardiac morbidity was most likely precipitated by the interaction of phenylephrine-induced hypertension with a cocaine-depressed myocardium.
Résumé
Il s agit d’un homme de 28 ans soumis à une anesthésie générale pour la réparation d’une lacération de la paupière et des voies lacrymales du côté droit. Après l’induction de l’anesthésie et l’application locale de phényléphrine (0,25%), il présente une élévation transitoire de la pression artérielle traitée immédiatement avec du labétalol. Par la suite, il développe un oedème pulmonaire aigu qui répond au traitement à (a morphine et au furosémide. Les diagnostic d’oedème pulmonaire est confirmé par l’analyse de gaz artériels, la radiographie pulmonaire et des échocardiographies séquentielles. L’investigation subséquente révèle qu’il est un habitué de la cocaïne laquelle est détectée dans son urine. Comme le patient est jeune et que son état de santé est bon, il est peu plausible que la phényléphrine ait été la principale cause de l’oedème pulmonaire. L’incident cardiaque a plutôt été précipité par l’action de l’hypertension induite par la phényléphrine sur un myocarde déjà déprimé par la cocaïne.
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Singh, P.P., Dimich, I. & Shamsi, A. Intraoperative pulmonary oedema in a young cocaine smoker. Can J Anaesth 41, 961–964 (1994). https://doi.org/10.1007/BF03010938
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DOI: https://doi.org/10.1007/BF03010938