Sevoflurane-Induced Diffuse Alveolar Hemorrhage

Abstract

Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary pathology which results in intra-alveolar hemorrhage secondary to disruption of the alveolar capillary basement membrane. Most commonly, these patients present with hemoptysis, hypoxemia and pulmonary infiltrates. Although rare, sevoflurane, an inhalational anesthetic used as a rapid induction agent for anesthesia may be implicated in the etiology of DAH. We report a case of a 21-year-old otherwise healthy male found to have postoperative diffuse alveolar hemorrhage secondary to sevoflurane inhalation. Thus far, only five documented cases describing sevoflurane induced diffuse alveolar hemorrhage have been described in the literature, with prior cases also showing a clear temporal association between sevoflurane administration and symptom onset. Although uncommon, we must take sevoflurane into consideration as a possible etiology of diffuse alveolar hemorrhage when encountering signs of respiratory distress and hemoptysis in postoperative patients.

Keywords: Anesthesia; Critical Care; Diffuse Alveolar Hemorrhage; Respiratory Distress; Sevoflurane.

Fig. 1

Chest CT axial section - Extensive bilateral abnormal lung opacities, which are more prominent in the perihilar regions of the lungs, but are scattered within all lobes of the lungs.