An acute postoperative intractable hyperventilation after an endoscopic third ventriculostomy

Abstract

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO(2), 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure.

Keywords: Central neurogenic hyperventilation; Endoscopic third ventriculostomy; Sedation.

Fig. 1

Preoperative magnetic resonance image (A : Axial, T2-weighted, B : Saggital, T1-enhanced) showing lateral and third ventricular enlargement.

Fig. 2

Respiratory changes during hyperventilation period. Respiratory rate was slowly decreased to 20 breaths per minute during 21 hrs.