title: Anaesthetic, procedure and complications management of serial whole-lung lavage in an obese patient with pulmonary alveolar proteinosis: case report.
abstract: OBJECTIVE
  The first case of Pulmonary Alveolar Proteinosis (PAP) was described by Rose in 1958, but it is still a rare disorder. PAP is characterized by deposition of lipoproteinaceous material secondary to abnormal processing of surfactant by macrophages. Patients may suffer from progressive dyspnea and cough that at times is accompanied by worsening hypoxia and its course can vary from progressive deterioration to spontaneous improvement. Many therapies have been used to treat PAP including antibiotics, postural drainage, and intermittent positive pressure breathing with aerosolized Acetylcysteine, heparin and saline. At present, the mainstay of treatment is whole lung lavage (WLL). Although generally well tolerated, WLL can be associated with some complications.
  
  
  METHODS
  We report a case of severe PAP through the anaesthetic, procedure and complications management of pulmonary alveolar proteinosis in one patient who has undergone multiple, alternating, single-lung lavages over the past seven years, the last three in our hospital, with improvements in her symptoms following each therapy.
authors.affiliation: Anesthesiology Service, Hospital São João, Brazil. helena.rebelo.net@gmail.com
authors.forename: Helena Marta
authors.initials: HM
authors.lastname: Rebelo
authors.forename: Luisa
authors.initials: L
authors.lastname: Guedes
authors.forename: Dalila
authors.initials: D
authors.lastname: Veiga
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Fiuza
authors.forename: Fernando
authors.initials: F
authors.lastname: Abelha
mesh_terms: D000758:Anesthesia / Q000379:methods*; D018893:Bronchoalveolar Lavage / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications / Q000628:therapy*