[A case of acute exacerbation of interstitial pneumonia after appendectomy managed with spinal anesthesia].
An 88-year-old woman was admitted with acute appendicitis. She had been treated with prednisolone and home oxygen therapy for interstitial pneumonia. Her respiratory state on admission was Grade 2 of Hugh-Jones' classification, and plasma KL-6 and SP-D levels were high. Seven days after the admission, appendectomy was performed under spinal anesthesia. Spinal anesthesia was initiated by injecting 0.5% hyperbaric bupivacaine 2.0ml into L3-4 interspace, and achieved block level was up to T4. During the operation, her respiratory state was stable, but after the operation, dry cough, increase of body temperature, and dyspnea were observed. Chest roentgenogram revealed severe ground glass appearance and reticular shadows bilaterally. Steroid therapy for acute exacerbation of interstitial pneumonia was initiated, but she died on the 13th POD. This case teaches us to take a lot of care in the management of a patient with high plasma level of KL-6 and SP-D.
Department of Anesthesiology, National Hospital Organization Kumamoto Medical Center, Kumamoto 860-0008.
Atsushi
A
Kotera
Seiji
S
Kouzuma
Naoki
N
Miyazaki
Kenichiro
K
Taki
Kimiaki
K
Esaki
D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D001062:Appendectomy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000503:physiopathology*; D018396:Mucin-1 / Q000097:blood; D011183:Postoperative Complications; D037721:Pulmonary Surfactant-Associated Protein C / Q000097:blood
C060192:MUC1 protein, human; D018396:Mucin-1; D037721:Pulmonary Surfactant-Associated Protein C