Agrawal O1, Mittal A1, Panwar VK1, Mishra M2, Kumar G2 and Bala M2*
1Department of Urology, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
2Department of Pulmonary Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
presents with hemoptysis and respiratory distress. No case has been ever reported in literature of
DAH as a complication of general anesthesia in robotic surgery secondary to inhaled anesthetic
Case Report: A 33 years old man, hypertensive on dual antihypertensive case of left pelviureteric
junction obstruction was admitted for left robot assisted pyeloplasty. He had no significant
respiratory history, was a nonsmoker and denied any illicit drug use and preoperative examination
was unremarkable. Anesthesia was induced by propofol and fentanyl and anesthetic effect was
maintained with sevoflurane. Intraoperative anesthesia period and post anesthesia recovery was
uneventful. On post-operative day 1, patient acutely desaturated and developed mild respiratory
distress. Patient then had 5 episodes of mild hemoptysis. Chest examination revealed bilateral coarse
inspiratory crepitations. Urgent chest radiograph revealed bilateral perihilar patchy opacities. HRCT
chest done subsequently showed multifocal air space opacifications suggestive of DAH. Later post
stabilization patient underwent bronchoscopy that corroborated with our initial diagnosis of DAH.
Discussion: Possible differential diagnoses included negative pressure ventilator induced DAH,
sevoflurane induced lung injury, arteriovenous malformation or a vasculitic process. Based on
history, blood investigations, imaging and evidence from literature we confirmed the diagnosis of
DAH due to sevoflurane use.
Conclusion: Use of sevoflurane in general anesthesia might result in DAH and its prudent to avoid
halogenated anesthetic agents in such patients if further anesthesia is required in such patients in
Diffuse alveolar hemorrhage, Robot assisted pyeloplasty; Sevoflurane complication;
Complications in robotic surgery
Agrawal O, Mittal A, Panwar VK, Mishra M, Kumar G, Bala M. Diffuse Alveolar Hemorrhage: A Rare Complication of Sevoflurane Use in Robot Assisted Pyeloplasty. Ann Clin Med Res. 2021;2(7): 1048..