1. Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance.
- Author
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Baettig, Sascha Jan, Fend, Raluca Ruxandra, Gero, Daniel, Gutschow, Christian, and Schlaepfer, Martin
- Subjects
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HERNIA surgery , *DISEASE exacerbation , *RESPIRATORY alkalosis , *LAPAROSCOPY , *MORPHINE , *CLONIDINE , *ALLERGIES , *SEVERITY of illness index , *TREATMENT effectiveness , *SURGICAL complications , *TRACHEA intubation , *RECOVERY rooms , *DICLOFENAC , *HYPERLACTATEMIA , *WATER-electrolyte imbalances , *FUNDOPLICATION , *COUGH , *LORAZEPAM , *DISEASE complications ,DIGESTIVE organ surgery - Abstract
Background: The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. Case presentation: A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. Conclusions: This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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