Sevoflurane-Induced Diffuse Alveolar Hemorrhage Following Strabismus Surgery: A Rare Event in the Emergency Department.

BACKGROUND: Sevoflurane is a widely used agent for the rapid induction and maintenance of anesthesia. Diffuse alveolar hemorrhage (DAH) is characterized by acute onset of alveolar infiltrates and hypoxemia, resulting in progressive alveolar bleeding that requires urgent treatment. This report highlights the potential role of inhaled tranexamic acid (TXA) as an adjunctive therapy in DAH.

CASE REPORT: A 29-year-old male, ASA-I patient underwent outpatient strabismus surgery. The patient presented to the emergency department (ED) with hypoxia and hemoptysis. These symptoms manifested within the first hour after surgery in the anesthesia unit. Based on the clinical findings, a diagnosis of DAH was established. The patient's hypoxemic respiratory distress was managed with high-flow nasal cannula (HFNC). For DAH, the patient was treated with intravenous glucocorticoids (1 mg/kg for 3 days) and a single 1 g dose of inhaled TXA. At discharge, the patient had no residual symptoms and abnormal clinical findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The popularity of outpatient surgery units is increasing; therefore, emergency and critical care clinicians should be particularly vigilant with post-anesthesia patients. The association between sevoflurane and DAH has not yet been fully elucidated. Further research is required to clarify the underlying pathophysiological mechanisms. DAH is a potentially fatal clinical condition. Clinicians must remain vigilant and be prepared to implement rapid resuscitation strategies. Inhaled TXA may form part of such strategies; however, further randomized controlled trials are required.