Abstract
BackgroundHyperventilation syndrome (HVS) sometimes occurs in patients under stressful conditions and may provoke severe complications such as myocardial infarction and death. The authors report a case of HVS following general anesthesia, where a continuous intravenous infusion of dexmedetomidine was effective for HVS.Case presentationA 23-year-old male patient with recurrent tongue cancer was scheduled to undergo partial glossectomy and neck dissection. Emergence from general anesthesia was prompt. Twenty-two minutes after extubation, the patient complained of unbearable distress caused by the urinary catheter. He began to cry, with an increased respiratory rate of over 40 breaths per minute. Intravenous infusion of flurbiprofen, droperidol, and morphine was not effective. Electrocardiography and laryngofiberscopy indicated the absence of acute coronary syndrome and airway obstruction, respectively. An arterial blood gas determination showed pH 7.63, PaCO2 18.2 mmHg, PaO2 143 mmHg on O2 mask 4 L/min, Ca2+ 4.29 mmol/L, and lactate 3.4 mmol/L. The patient was diagnosed with HVS. Dexmedetomidine infusion 2.0 μg/kg/h for 10 min followed by 0.7 μg/kg/h reduced respiratory rate, suppressed arousal, and disappeared the complaint of bladder distension. One hour after extubation, an arterial blood gas determination showed pH 7.33, PaCO2 51.3 mmHg, PaO2 196 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.5 mmol/L. After admission to the intensive care unit, dexmedetomidine infusion was maintained at the rate of 0.2 to 0.7 μg/kg/h until the following morning, and he did not complain of distress caused by the urinary catheter.ConclusionsHVS can occur after emergence from general anesthesia, and dexmedetomidine infusion was effective for HVS.
Highlights
Hyperventilation syndrome (HVS) sometimes occurs in patients under stressful conditions and may provoke severe complications such as myocardial infarction and death
HVS can occur after emergence from general anesthesia, and dexmedetomidine infusion was effective for HVS
Dexmedetomidine infusion was effective for HVS
Summary
Hyperventilation syndrome (HVS) may occur in relatively young patients under a stressful condition. Case presentation A 23-year-old male patient with recurrent tongue cancer was scheduled to undergo partial glossectomy and neck dissection His height and body weight were 171 cm and 76.1 kg, respectively. An initial arterial blood gas determination showed pH 7.38, PaCO2 45.2 mmHg, PaO2 193 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.3 mmol/ L 10 min after extubation. An arterial blood gas determination showed pH 7.63, PaCO2 18.2 mmHg, PaO2 143 mmHg on O2 mask 4 L/min, Ca2+ 4.29 mmol/L, and lactate 3.4 mmol/ L. Arterial blood gas analysis showed pH 7.33, PaCO2 51.3 mmHg, PaO2 196 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.5 mmol/ L. After admission to the intensive care unit, dexmedetomidine infusion was maintained at the rate of 0.2 to 0.7 μg/kg/h until the following morning, and he did not complain of distress caused by the urinary catheter
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