Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report
Relapsing polychondritis (RP) is a rare autoimmune disorder that causes inflammation and deterioration of cartilaginous structures such as the ears, nose, joints and laryngotracheobronchial tree. A 42-year-old man receiving treatment for RP underwent open reduction and internal fixation of a femur f...
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| Format: | Article |
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MDPI AG
2022-12-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/1/65 |
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| author | Jaesang Lee Hosik Moon Sungjin Hong Jinyoung Chon Hyejin Kwon Hunwoo Park Jiyung Lee |
| author_facet | Jaesang Lee Hosik Moon Sungjin Hong Jinyoung Chon Hyejin Kwon Hunwoo Park Jiyung Lee |
| author_sort | Jaesang Lee |
| collection | DOAJ |
| description | Relapsing polychondritis (RP) is a rare autoimmune disorder that causes inflammation and deterioration of cartilaginous structures such as the ears, nose, joints and laryngotracheobronchial tree. A 42-year-old man receiving treatment for RP underwent open reduction and internal fixation of a femur fracture under spinal anesthesia and with sedation by propofol and remifentanil. The level of sedation was monitored via a bispectral index (BIS), and maintained at between 60 and 80. At the end of the operation, he lost consciousness and displayed weak respiratory effort. During mask ventilation, the patient was judged to have respiratory failure due to high end-tidal CO<sub>2</sub> (EtCO<sub>2</sub>) concentration and respiratory acidosis in an arterial-blood-gas analysis (ABGA). Ventilation through a properly inserted laryngeal-mask-airway or endotracheal intubation were impossible; instead, a surgical tracheotomy was performed. After recovering from respiratory failure with ventilatory support in the intensive care unit (ICU), he experienced the same symptoms three more times, requiring ventilatory support. He was discharged with bilevel positive-airway-pressure (BiPAP), after successful adaptation. |
| first_indexed | 2024-03-09T11:45:17Z |
| format | Article |
| id | doaj.art-3559a3aa3d9b42c095e3e899ceb1cb91 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T11:45:17Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-3559a3aa3d9b42c095e3e899ceb1cb912023-11-30T23:23:52ZengMDPI AGMedicina1010-660X1648-91442022-12-015916510.3390/medicina59010065Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case ReportJaesang Lee0Hosik Moon1Sungjin Hong2Jinyoung Chon3Hyejin Kwon4Hunwoo Park5Jiyung Lee6Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaRelapsing polychondritis (RP) is a rare autoimmune disorder that causes inflammation and deterioration of cartilaginous structures such as the ears, nose, joints and laryngotracheobronchial tree. A 42-year-old man receiving treatment for RP underwent open reduction and internal fixation of a femur fracture under spinal anesthesia and with sedation by propofol and remifentanil. The level of sedation was monitored via a bispectral index (BIS), and maintained at between 60 and 80. At the end of the operation, he lost consciousness and displayed weak respiratory effort. During mask ventilation, the patient was judged to have respiratory failure due to high end-tidal CO<sub>2</sub> (EtCO<sub>2</sub>) concentration and respiratory acidosis in an arterial-blood-gas analysis (ABGA). Ventilation through a properly inserted laryngeal-mask-airway or endotracheal intubation were impossible; instead, a surgical tracheotomy was performed. After recovering from respiratory failure with ventilatory support in the intensive care unit (ICU), he experienced the same symptoms three more times, requiring ventilatory support. He was discharged with bilevel positive-airway-pressure (BiPAP), after successful adaptation.https://www.mdpi.com/1648-9144/59/1/65airwaybispectral indexrelapsing polychondritisrespiratory failuresedationspinal anesthesia |
| spellingShingle | Jaesang Lee Hosik Moon Sungjin Hong Jinyoung Chon Hyejin Kwon Hunwoo Park Jiyung Lee Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report Medicina airway bispectral index relapsing polychondritis respiratory failure sedation spinal anesthesia |
| title | Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report |
| title_full | Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report |
| title_fullStr | Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report |
| title_full_unstemmed | Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report |
| title_short | Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report |
| title_sort | respiratory failure during bis guided sedation in a patient with relapsing polychondritis a case report |
| topic | airway bispectral index relapsing polychondritis respiratory failure sedation spinal anesthesia |
| url | https://www.mdpi.com/1648-9144/59/1/65 |
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