Acute post-operative diffuse alveolar haemorrhage after sevoflurane general anaesthesia: A case report

This is the authors' abstract. We don't add key points for this paper.

Background: Diffuse alveolar haemorrhage (DAH) is an uncommon but potentially life-threatening cause of acute postoperative respiratory deterioration. Recognition may be delayed because more common causes of postoperative hypoxaemia are usually considered first. Case Presentation: A previously healthy young male developed sudden cough, haemoptysis, hypoxaemia, and bilateral pulmonary infiltrates shortly after an otherwise uncomplicated surgery under sevoflurane-based general anaesthesia. Bronchoscopy demonstrated diffuse fresh alveolar bleeding without a focal endobronchial source, with progressively haemorrhagic bronchoalveolar lavage samples, confirming the diagnosis of DAH. A comprehensive evaluation did not identify an alternative infectious, autoimmune, coagulation-related, thromboembolic, cardiac, or airway-related cause. The patient was managed conservatively with oxygen therapy, corticosteroids, nebulised tranexamic acid, and close monitoring, with progressive clinical and radiological improvement.Conclusion: DAH should be considered when postoperative hypoxaemia is accompanied by haemoptysis, new bilateral alveolar infiltrates, and a falling haemoglobin concentration. Early bronchoscopy and supportive management were associated with rapid clinical and radiological recovery in this patient. The temporal relationship and exclusion of alternative causes suggest sevoflurane as a probable trigger, although causality cannot be established from a single case.