Korean J Crit Care Med.  1999 Nov;14(2):176-180.

Recurrent Intracerebral Hemorrhage after Extubation in a Hypertensive Patient: A case report

• Lee JH
• Lim HS
• Nam KH
• Lee SJ
• Lee KN
• Moon JI

Abstract

Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.

Keyword

Complications; intracerebral hemorrhage; Hypertension; Recovery; extubation

MeSH Terms

Airway Extubation
Anesthesia
Anoxia
Blood Pressure
Brain
Cerebral Hemorrhage*
Consciousness
Emergencies
Extremities
Female
Hemorrhage
Humans
Hypercapnia
Hypertension
Hysterectomy
Intracranial Hemorrhage, Hypertensive
Middle Aged
Myocardial Infarction
Putamen
Tachycardia