Successful transition from intravenous to inhalation anesthesia for respiratory management of coronavirus disease pneumonia: A case report

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery Pub Date : 2024-10-16 DOI:10.1002/ams2.70010

Reijiro Kato, Yuhei Irie, Yoshito Izutani, Hiroyasu Ishikura

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Abstract

Background

In patients with coronavirus disease pneumonia, strong spontaneous breathing increases pulmonary vascular permeability and induces self-inflicted lung injury, prolonging the intensive care unit stay and worsening prognosis. Therefore, spontaneous respiration must be strictly controlled.

Case Presentation

A 48-year-old man was admitted for respiratory management of severe coronavirus disease pneumonia. Despite immediate ventilatory management, ventilatory failure and air leak syndrome developed, necessitating venovenous extracorporeal membrane oxygenation, intravenous sedation, and muscle relaxation. Over time, the patient's inspiratory effort worsened and the requirement for transvenous anesthesia increased. Therefore, management was switched to inhalation anesthesia after discontinuation of all transvenous anesthetics, maintaining morphine-only analgesia. Subsequent management enabled effective control of spontaneous respiration, allowing eventual discontinuation of inhalation anesthesia, venovenous extracorporeal membrane oxygenation, and ventilation.

Conclusion

Management of spontaneous respiration in coronavirus disease pneumonia can be complicated by resistance to transvenous anesthesia; however, the use of an inhaled anesthetic may present a valuable alternative.

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冠状病毒性肺炎呼吸治疗从静脉麻醉到吸入麻醉的成功过渡：病例报告

背景在冠状病毒肺炎患者中，强烈的自主呼吸会增加肺血管通透性，诱发自身肺损伤，延长重症监护室的住院时间，恶化预后。因此，必须严格控制自主呼吸。病例介绍一名 48 岁男子因重症冠状病毒肺炎入院接受呼吸治疗。尽管立即进行了呼吸管理，但还是出现了呼吸衰竭和漏气综合征，需要静脉体外膜肺氧合、静脉镇静和肌肉松弛。随着时间的推移，患者的吸气功能越来越差，对经静脉麻醉的需求也随之增加。因此，在停用所有经静脉麻醉药后，改为吸入麻醉，并维持仅吗啡镇痛。随后的治疗有效控制了患者的自主呼吸，最终停止了吸入麻醉、静脉体外膜氧合和通气。结论冠状病毒病肺炎患者的自主呼吸管理可能会因经脉麻醉的阻力而变得复杂；然而，使用吸入麻醉剂可能是一种有价值的替代方法。

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来源期刊

Acute Medicine & Surgery MEDICINE, GENERAL & INTERNAL-

自引率

12.50%

发文量

审稿时长

53 weeks