자궁내막 제거술 중 확장매질로 인한 폐부종

Abstract

Dextran are used as distension media to help visualize the uterine cavity during diagnostic and operative hysteroscopy and are also used for volume expansion and their antithrombogenic effect. But dextran have significant side effects including pulmonary edema, coagulation defects, anaphylaxis and acute renal failure. We experienced a case of pulmonary edema following hysteroscopic guided endometrial resection. A 41-year-old female was performed the operation under general anesthesia, and the time of tion was approximately 90 minutes, and 1000 ml of rheomacrodex(10% dextran 40 in 5% dextrose in water) was instilled during the procedure. At the end of the operation, we noted a drop in oxygen saturation, engorgement of neck vein and watery pink tinged sputum in the endotracheal tube. Chest x-ray was taken and showed pulmonary edema. The patient was transferred to the intensive care unit where therapy was instituted including positive pressure mechanical ventilation and negative balanced fluid therapy with intravenous push of furosemide. The patient was extubated after 1 day with ventilator care and transferred to general ward on 2nd postoperative day and discharged on 5th postoperative day without any complication.