A case of asthma attack in cardiac surgery because of an inflammatory reaction induced by extracorporeal circulation

Abstract

　We encountered a case of asthma attack during cardiac surgery using an extracorporeal circulation. The patient had a history of asthma, but was in symptom-free remission at the time of surgery. When artificial respiration resumed after the aortic declamp, an increase in inspiratory pressure and wheezing were observed, making it difficult to withdraw from the extracorporeal circulation. After inhalation of sevoflurane and salbutamol, and intravenous administration of methylprednisolone, wheezing disappeared and extracorporeal circulation was successfully withdrawn. Continuous administration of a small quantity of adrenaline was started, and sevoflurane was discontinued. Asthma did not recur, and hemodynamics became stable. Asthma attacks induced by an extracorporeal circulation are thought to be caused by inflammatory substances such as complement and cytokines that are released after the contact of blood cells with the circuit and artificial lung. When using an extracorporeal circulation, attention should be paid to patients in asthma remission because of the risk of having an asthma attack.