Case 20: Pulmonary Edema Following Abdominal Laparoscopy

  • John G. Brock-Utne


A 69-year-old, 50 kg woman with pelvic pain is admitted for laparoscopic carbon dioxide laser lysis of pelvic adhesions. Her past history is significant for hypertension and hyperlipidemia. The clinical exam is unremarkable, and although there are no cardiac symptoms, a preoperative ECG shows a left anterior fascicular block. Her medication includes hydrochlorothiazide, triamterene, and gemfibrozil. She is not allergic to any medication. She is sedated with midazolam 2 mg IV and taken to the operating room. Thereafter monitors are placed, and she has a successful induction of general endotracheal anesthesia. She is maintained with desflurane/fentanyl/oxygen/air mixture. Vecuronium is used for muscle relaxation. During the operation the patient receives a total of 2100 ml of crystalloid fluid IV over the 185 min procedure (1000 mL Lactate Ringer’s solution before the procedure started, 1000 mL 0.9% saline during the first 90 min and 100 ml 0.9% saline during the final 95 min). The surgeon infuses a lactated Ringer’s solution through the laparoscope to wash away blood and debris and thereby improve visualization.


Pulmonary edema Laparoscopy General anesthesia ECG Carbon dioxide laser Fluid balance Intraperitoneal fluid Furosemide Sodium 


  1. 1.
    Healzer JM, Nezhat C, Brodsky JB, Brock-Utne JG, Seidman DS. Pulmonary edema after absorbing crystalloid irrigating fluid during laparoscopy. Anesth Analg. 1994;78:1207.CrossRefPubMedGoogle Scholar
  2. 2.
    Hong SJ, Lee JY, Chjoi JH, Lee HJ, Choi CH. Pulmonary edema following laparscopic bariatric surgery. Obes Surg. 2005;15(8):1202–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Hong JY, Oh YJ, Rha KH, Park WS, Kil HK. Pulmonary edema after da Vinci assisted laparoscopic radical prostatectomy: A case report. J Clin Anesth. 2010;22(5):370–2.CrossRefPubMedGoogle Scholar
  4. 4.
    Hulka JF, Peterson HB, Phillips JM, Surrey MW. Operative hysteroscopy. Am Ass Gynecologic Laparoscopists 1991 Membership Survey. J Reprod Med. 1993;38:572–3.PubMedGoogle Scholar
  5. 5.
    Woo YC, Kang H, Cha SM, Jung YH, Kim JY, Koo GH, Park SG, Baek CW. Severe intraoperative hyponatremia associated with the absorption of irrigation fluid during hysteroscopic myomectomy: A case report. J Clin Anesth. 2011;23(8):649–52.CrossRefPubMedGoogle Scholar
  6. 6.
    van Boven MJ, Singelyn F, Donnez J, Gribomont BF. Dilutional hyponatremia associated with intrauterine endoscopic laser surgery. Anesthesiology. 1989;71:449–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Carson SA, Hubert GD, Schriock ED, Buster JE. Hyperglycemia and hyponatremia during operative hysteroscopy with 50% dextrose. Fertil Steril. 1989;51:341–3.CrossRefPubMedGoogle Scholar
  8. 8.
    D’Agosto J, Ali NMK, Maier D. Absorption of irrigating solutions during hysteroscopy: hysteroscopy syndrome. Anesthesiology. 1990;72:379–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Mangar D. Anaesthetic implications of 32% dextran-70 (Hyskon) during hysteroscopy: Hysteroscopy syndrome. Can J Anaesth. 1992;39(9):975.CrossRefPubMedGoogle Scholar
  10. 10.
    Monastesse A, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Lung ultrasonography for the assessment of perioperative atelectasis: A pilot feasibility study. Anesth Analg. 2017 Feb;124(2):494–504.CrossRefPubMedGoogle Scholar
  11. 11.
    Girard M, Généreux V, Monastesse A. Lung ultrasonography for the detection of anesthesia induced lung atelectasis. Anesthesiology. 2015;122(1):213–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • John G. Brock-Utne
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA

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