Casoni, Daniela; Giovannini, Annalisa Elena; Precht, Maria Christina; Adami, Chiara (2016). A possible case of neurogenic pulmonary edema in a sheep following intracranial surgery. Journal of Clinical Anesthesia and Management, 1(3) Sci Forschen 10.16966/2470-9956.110
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Abstract
Objective: To describe presentation, treatment and outcome of a sheep that developed acute respiratory distress after intracranial surgery.
Case summary: A 3-year-old female crossbred sheep weighing 64 kg was anaesthetized for intracranial surgery as a part of a research
project. Premedication and induction of anesthesia were uneventful as well as tracheal intubation. Anesthesia was maintained with isoflurane in a
50% mixture of oxygen and air, fentanyl (5-15 μg kg-1h-1) and lidocaine (1.8 mg kg-1h-1). During anesthesia, an increased alveolar-arterial oxygen
gradient was calculated on the basis of arterial blood gas analysis: inspiratory fraction of oxygen was increased and a recruitment manoeuvre
was performed. After 210 minutes of anesthesia, the sheep was let recover with oxygen supplementation under monitoring of pulse-oxymetry,
capnography, inspired and expired oxygen, temperature and invasive blood pressure. At tracheal extubation no signs of regurgitation or aspiration
were noticed. Twenty-five minutes later, the sheep showed deterioration of neurological status and clonic seizure responsive to diazepam. After
transient tachycardia, blood pressure rose acutely and sinus bradycardia followed. Severe tachypnea started in few minutes accompanied by loud
respiratory noises and harsh diffuse crackles on both sides of the thorax. Foamy blood nasal exudates discharged from the nostrils. Neurogenic
pulmonary edema as a sequel of increased intracranial pressure was suspected and treated with intravenous mannitol (0.5 gkg-1) and furosemide
(4 mgKg-1). Hypoxemia was successfully managed with oxygen supplementation. Motor and cognitive functions improved progressively and were
deemed normal within 12 hours from the episode, when arterial partial pressure of oxygen was 11.7 kPa (88 mmHg) at room air.
New information provided: Severe pulmonary complications may be observed after iatrogenic neurological injury in sheep. Neurogenic
pulmonary edema should be taken into account among the differential diagnoses of abrupt respiratory distress following seizure.
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