Kinoshita Hirotaka, Kato Kodai, Yamazaki Yuma, Hashiba Eiji, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, JPN.
Division of Intensive Care, Hirosaki University Hospital, Hirosaki, JPN.
Cureus. 2024 Feb 25;16(2):e54850. doi: 10.7759/cureus.54850. eCollection 2024 Feb.
Clazosentan, a potent selective endothelin receptor subtype A antagonist, has been demonstrated to be effective in preventing cerebral vasospasms after subarachnoid hemorrhage. We report the successful management of respiratory failure due to pulmonary edema associated with clazosentan, with a hemodynamic monitoring system. A 49-year-old Japanese man underwent emergency clipping for a right internal carotid-posterior communicating artery aneurysm. The surgery and general anesthesia for the rupture proceeded with no complications. Clazosentan was administered from postoperative day 1 to prevent cerebral vasospasm. He presented with respiratory failure six days post surgery and chest X-ray imaging showed pulmonary edema. In our intensive care unit, the patient's N-terminal pro-brain natriuretic peptide was 476 pg/mL although trans-thoracic echography indicated a normal left ventricular ejection fraction (>60%) and normal diastolic function. The hemodynamic monitoring system showed 11 L/minute cardiac output and a cardiac index of 5.6 L/minute/m. We thus diagnosed the cause of the patient's respiratory failure as due to excessive volume, as an adverse event of clazosentan. We changed the cerebral vasospasm-preventive drug to fasudil hydrochloride hydrate and forced urination. His body weight dropped approximately 9 kg as of day 9 in the ICU and he was weaned off the ventilator 23 days post surgery. This case indicates the importance of optimal infusion in patients with clazosentan. Optimal fluid management using a hemodynamic monitoring system could be useful for clazosentan-induced respiratory failure.
克拉生坦是一种强效的选择性内皮素A受体拮抗剂，已被证明可有效预防蛛网膜下腔出血后的脑血管痉挛。我们报告了一例使用血流动力学监测系统成功处理克拉生坦相关肺水肿所致呼吸衰竭的病例。一名49岁的日本男性因右侧颈内动脉-后交通动脉瘤接受了急诊夹闭手术。手术及破裂后的全身麻醉过程均未出现并发症。术后第1天开始使用克拉生坦以预防脑血管痉挛。术后6天，他出现呼吸衰竭，胸部X线影像显示肺水肿。在我们的重症监护病房，患者的N末端脑钠肽前体为476 pg/mL，尽管经胸超声心动图显示左心室射血分数正常（>60%）且舒张功能正常。血流动力学监测系统显示心输出量为11 L/分钟，心脏指数为5.6 L/分钟/平方米。因此，我们将患者呼吸衰竭的原因诊断为克拉生坦的不良事件导致的容量过多。我们将预防脑血管痉挛的药物改为盐酸法舒地尔并强制利尿。截至在重症监护病房的第9天，他的体重下降了约9 kg，术后23天脱机。该病例表明了克拉生坦治疗患者中优化输液的重要性。使用血流动力学监测系统进行优化的液体管理可能对克拉生坦所致呼吸衰竭有用。
