Procedimento e complicações anestésicas no manejo de lavagem pulmonar total em paciente obeso com proteinose alveolar pulmonar: relato de caso

Helena Marta Rebelo; Luisa Guedes; Dalila Veiga; Antonio C. Fiuza; Fernando Abelha

doi:10.1590/S0034-70942012000600012

Clinical Information

Procedimento e complicações anestésicas no manejo de lavagem pulmonar total em paciente obeso com proteinose alveolar pulmonar: relato de caso

Anaesthetic, procedure and complications management of serial whole lung lavage in an obese patient with pulmonary alveolar proteinosis: case report

Helena Marta Rebelo; Luisa Guedes; Dalila Veiga; Antonio C. Fiuza; Fernando Abelha

http://dx.doi.org/10.1590/S0034-70942012000600012 Braz J Anesthesiol, vol.62, n6, p.873-877, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: O primeiro caso de proteinose alveolar pulmonar (PAP) foi descrito por Rose em 1958, mas ainda é um distúrbio raro. PAP é caracterizada pela deposição de material lipoproteico secundário ao processamento anormal de surfactantes pelos macrófagos. Os pacientes podem ter dispneia progressiva e tosse, às vezes acompanhadas pelo agravamento da hipóxia, e seu curso pode variar de deterioração progressiva a melhora espontânea. Muitas terapias foram usadas, incluindo antibióticos, drenagem postural e ventilação com pressão positiva intermitente com acetilcisteína, heparina e soro fisiológico em aerossol. Atualmente, a base do tratamento é a lavagem pulmonar total (LPT). A LPT, embora seja geralmente bem-tolerada, pode estar associada a algumas complicações. RELATO DE CASO: Relatamos um caso de PAP grave durante o procedimento anestésico e as complicações no manejo da proteinose alveolar pulmonar em um paciente que havia sido submetido a múltiplas e alternadas lavagens de um dos pulmões ao longo de sete anos (os últimos três em nosso hospital), com melhora dos sintomas depois de cada tratamento.

Palavras-chave

ANESTESIA, Geral, COMPLICAÇÕES; Lavagem Broncoalveolar, Proteinose Alveolar Pulmonar

Abstract

BACKGROUND AND OBJECTIVES: The first case of Pulmonary Alveolar Proteinosis (PAP) was described by Rose in 1958, but it is still a rare disorder. PAP is characterized by deposition of lipoproteinaceous material secondary to abnormal processing of surfactant by macrophages. Patients may suffer from progressive dyspnea and cough that at times is accompanied by worsening hypoxia and its course can vary from progressive deterioration to spontaneous improvement. Many therapies have been used to treat PAP including antibiotics, postural drainage, and intermittent positive pressure breathing with aerosolized Acetylcysteine, heparin and saline. At present, the mainstay of treatment is whole lung lavage (WLL). Although generally well tolerated, WLL can be associated with some complications. CASE REPORT: We report a case of severe PAP through the anaesthetic, procedure and complications management of pulmonary alveolar proteinosis in one patient who has undergone multiple, alternating, single-lung lavages over the past seven years, the last three in our hospital, with improvements in her symptoms following each therapy.

Keywords

Anesthesia, General, Broncoalveolar Lavage, Intraoperative Complications, Pulmonary Alveolar Proteinosis

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Procedimento e complicações anestésicas no manejo de lavagem pulmonar total em paciente obeso com proteinose alveolar pulmonar: relato de caso

Anaesthetic, procedure and complications management of serial whole lung lavage in an obese patient with pulmonary alveolar proteinosis: case report

Helena Marta Rebelo; Luisa Guedes; Dalila Veiga; Antonio C. Fiuza; Fernando Abelha

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