J Korean Neurosurg Soc.  2012 Mar;51(3):173-176. 10.3340/jkns.2012.51.3.173.

An Acute Postoperative Intractable Hyperventilation after an Endoscopic Third Ventriculostomy

• Lee HM
• Shin KB
• Kim SH
• Jee DL

• KMID: 2018195
• DOI: http://doi.org/10.3340/jkns.2012.51.3.173

Abstract

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO2, 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure.

Keyword

Central neurogenic hyperventilation; Endoscopic third ventriculostomy; Sedation

MeSH Terms

Benzodiazepines
Cold Temperature
Female
Fentanyl
Humans
Hyperventilation
Masks
Middle Aged
Oxygen
Respiratory Center
Respiratory Rate
Thiopental
Ventilation
Ventriculostomy
Benzodiazepines
Fentanyl
Oxygen
Thiopental

Figure

• 

  Fig. 1 Preoperative magnetic resonance image (A : Axial, T2-weighted, B : Saggital, T1-enhanced) showing lateral and third ventricular enlargement.

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  Fig. 2 Respiratory changes during hyperventilation period. Respiratory rate was slowly decreased to 20 breaths per minute during 21 hrs.

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