Anesthesia for Unilateral Lung Lavage in a Patient with Pulmonary Alveolar Proteinosis: A Case Report

Authors

  • Vanessa Oliveira Silva 3rd Year Resident of Anesthesiology, CET-SBA of the HCUFG, Goiânia, GO, Brazil Author
  • Luiz Eduardo Imbelloni Anesthesiologist at Various Hospitals, Rio de Janeiro, RJ, Brazil Author
  • Antonio Fernando Carneiro Professor of Anesthesiology at the UFG Faculty of Medicine, Responsible for the CET-SBA of the HCUFG, Goiânia, GO, Brazil Author
  • Marciano de Souza Nóbrega Master’s in Environmental Sciences and Health, Universidade Goiás, Brazil Author
  • Frederico Resende Azevedo Parreira Anesthesiologist at Various Hospitals, Goiânia, GO, Brazil Author
  • Anna Lúcia Calaça Rivoli Anesthesiologist at the National Cancer Institute (INCA), Brazil Author
  • Sylvio Valença de Lemos Net Head of the Anesthesiology Service of the National Cancer Institute (INCA) Anesthesiologist, Responsible for the CET-SBA of the National Cancer Institute, Rio de Janeiro, RJ, Brazil Author
  • Ana Cristina Pinho INCA Anesthesiologist, Co-Responsible for the CET-SBA of the National Cancer Institute, Rio de Janeiro, RJ, Brazil Author

DOI:

https://doi.org/10.47363/JMHC/2024(6)288

Keywords:

Pulmonary Alveolar Proteinosis, Rare Diseases, OneLung Ventilation Anesthesia, Whole-Lung Lavage

Abstract

Background: Pulmonary alveolar proteinosis (PAP) was first described in 1958. Basically, PAP is caused by an impairment of surfactant clearance or abnormal surfactant production, according to various pathogenetic mechanisms and different etiologies. In 90% of cases, it is an autoimmune disease compromising immunoglobulin (Ig)-G and anti-GM-CSF. The objective of this report is to show a case of a patient with severe PAP who was admitted to the emergency room with dyspnea and chest pain and was followed up by the pulmonology outpatient clinic and indicated for pulmonary lavage.

Case Report: A 38-year-old female patient, weighing 95 kg and measuring 155 cm tall, with dyspnea and chest pain with intensity 6/10 for 9 months, which had worsened for 3 months. Admitted to the emergency room with dyspnea, asthenia and chest pain. Diagnosis of PAP is performed through laboratory and imaging tests, with pulmonary lavage under intravenous general anesthesia being indicated. During right pulmonary lavage, 14 liters of warmed saline solution were infused, and 13.6 liters of fluid were drained, lasting 4 hours and resulting in a marked improvement in the symptoms, with the patient being extubated in the ICU 12 hours after the end of the procedure.

Conclusion: Pulmonary alveolar proteinosis is a rare disease that requires special attention during procedures such as whole lung lavage. Anesthetic management presents unique challenges, especially in patients with low pulmonary reserve and risk of hypoxemia, as observed in the reported case.

Author Biographies

  • Vanessa Oliveira Silva, 3rd Year Resident of Anesthesiology, CET-SBA of the HCUFG, Goiânia, GO, Brazil

    3rd Year Resident of Anesthesiology, CET-SBA of the HCUFG, Goiânia, GO, Brazil

  • Luiz Eduardo Imbelloni, Anesthesiologist at Various Hospitals, Rio de Janeiro, RJ, Brazil

    Anesthesiologist at Various Hospitals, Rio de Janeiro, RJ, Brazil

  • Antonio Fernando Carneiro, Professor of Anesthesiology at the UFG Faculty of Medicine, Responsible for the CET-SBA of the HCUFG, Goiânia, GO, Brazil

    Professor of Anesthesiology at the UFG Faculty of Medicine, Responsible for the CET-SBA of the HCUFG, Goiânia, GO, Brazil

  • Marciano de Souza Nóbrega, Master’s in Environmental Sciences and Health, Universidade Goiás, Brazil

    Master’s in Environmental Sciences and Health, Universidade Goiás, Brazil

  • Frederico Resende Azevedo Parreira, Anesthesiologist at Various Hospitals, Goiânia, GO, Brazil

    Anesthesiologist at Various Hospitals, Goiânia, GO, Brazil

  • Anna Lúcia Calaça Rivoli, Anesthesiologist at the National Cancer Institute (INCA), Brazil

    Anesthesiologist at the National Cancer Institute (INCA), Brazil

  • Sylvio Valença de Lemos Net, Head of the Anesthesiology Service of the National Cancer Institute (INCA) Anesthesiologist, Responsible for the CET-SBA of the National Cancer Institute, Rio de Janeiro, RJ, Brazil

    Head of the Anesthesiology Service of the National Cancer Institute (INCA) Anesthesiologist, Responsible for the CET-SBA of the National Cancer Institute, Rio de Janeiro, RJ, Brazil

  • Ana Cristina Pinho, INCA Anesthesiologist, Co-Responsible for the CET-SBA of the National Cancer Institute, Rio de Janeiro, RJ, Brazil

    INCA Anesthesiologist, Co-Responsible for the CET-SBA of the National Cancer Institute, Rio de Janeiro, RJ, Brazil

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Published

2024-12-09

Issue

Vol. 6 No. 12 (2024): Volume 6 Issue 12

Section

Articles