Noncardiogenic pulmonary edema in a cardiac surgery patient: Never a welcome sight for the anesthesiologist

摘要

A 78-YEAR-OLD woman presented for redo aortic and mitral valve replacement and primary tricuspid valve repair. Aside from New York Heart Association Class IV congestive heart failure on the basis of a ruptured bioprosthetic mitral valve, her past medical history was relatively noncontributory. Anesthesia was induced in a hemodynamically neutral fashion, and anticoagulation was achieved with 30,000 IU of heparin and supplemented to maintain an activated coagulation time of greater than 500 seconds. The patient received a 4-g bolus of tranexamic acid followed by an infusion of 1 g/h. Intravenous hydrocortisone (100 mg) was administered because of the anticipated duration of cardiopulmonary bypass (CPB) time.