Endobronchial hemorrhage after intubation with double-lumen endotracheal tube in a patient with idiopathic thrombocytopenic purpura for minimally invasive cardiac surgery: a case report
Korean Journal of Anesthesiology 2014³â 66±Ç 1È£ p.59 ~ p.63
±èÈñ¿µ(Kim Hee-Young) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
¹é½ÂÈÆ(Baek Seung-Hoon) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
±è°æÈ£(Kim Kyoung-Hoon) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
±è³²¿ø(Kim Nam-Won) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
Abstract
Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.
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Cardiac surgery, Double-lumen endotracheal tube, Endobronchial hemorrhage, Idiopathic thrombocytopenic purpura, Minimally invasive surgical procedures
KMID :
0356920140660010059
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