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Hyperventilation Syndrome After Strabismus Surgery - A Case Report

Received: 23 April 2023     Accepted: 10 May 2023     Published: 17 May 2023
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Abstract

Hyperventilation syndrome (HVS) mainly occurs in patients under anxiety and stress and is marked by rapid, excessive breathing, resulting in respiratory alkalosis and subsequent hypocalcemia and hypokalemia, causing various physical symptoms, like numbness or tingling sensation, overactive reflexes, muscle cramps, twitches, and in severe cases, acute myocardial infarction or even death, requiring immediate diagnosis and medical intervention. We report a rare case of HVS after strabismus surgery under local anesthesia. The patient is a healthy 31-year-old woman with no psychiatric or other diseases in the past medical history. At the end of the procedure, as soon as the surgeon uncovered the sheet, the patient complained about numbness in the lower limbs, spasm in the upper limbs, muscle rigidity, and double vision. At that time, the electrocardiogram monitoring showed normal blood pressure, heart rate, pulse oxygen saturation, and breathing rate. However, the patient was awake and extremely nervous. Emergency arterial blood gas analysis (ABG) was performed immediately and revealed respiratory alkalosis with significantly reduced PaCO2 and secondary hypocalcemia and hypokalemia. Verbal reassurance, closed-mask inhalation, and electrolyte supplement were administered. HVS gradually subsided. In this context, a prompt differential diagnosis and a high degree of suspicion are essential. Monitoring end-tidal carbon dioxide may also aid in the early detection of HVS, as changes in breathing rate and pattern may be observed before definite signs and symptoms manifest in patients with HVS. However, since surgical drapes and trays cover the torso, detecting any changes in breathing rate and pattern during the surgery may be challenging. This article describes a case of HVS after strabismus surgery under local anesthesia and provides a summary of the occurrence, manifestation, diagnosis, and treatment of HVS. It is hoped that this article will facilitate the prompt identification and appropriate treatment of HVS, thereby preventing any potential negative outcomes for the patients. Additionally, HVS is a rare complication during the perioperative period and has only been reported in a small number of case reports. Therefore, further research is needed to confirm the effectiveness of measures for prevention and treatment mentioned in the text.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)
DOI 10.11648/j.ijacm.20231101.18
Page(s) 35-37
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Hyperventilation Syndrome, Anesthesia, Strabismus Surgery

References
[1] Gardner WN. The pathophysiology of hyperventilation disorders. Chest. 1996; 109: 516-34.
[2] Moon HS, Lee SK, Chung JH, In CB. Hypocalcemia and hypokalemia due to hyperventilation syndrome in spinal anesthesia -A case report. Korean J Anesthesiol. 2011; 61: 519-23.
[3] Craig BA, Panni MK. Hyperventilation-induced transient spastic quadraparesis. Br J Anaesth. 2004; 93: 474-5.
[4] Chelmowski MK, Keelan MH, Jr. Hyperventilation and myocardial infarction. Chest. 1988; 93: 1095-6.
[5] Bouras N, Kartsounis LD, Bridges PK. Death associated with hyperventilation. Lancet. 1987; 2: 568.
[6] Fangio P, De Jonghe B, Lacherade JC, Terville JP, Outin H. Coronary spasm in a 59-yr-old woman with hyperventilation. Can J Anaesth. 2004; 51: 850-1.
[7] Tomioka S, Enomoto N, Momota Y. Hyperventilation syndrome after general anesthesia. J Anaesthesiol Clin Pharmacol. 2015; 31: 284-5.
[8] Paquin-Lanthier G, Rogan K, McGuire G, Chowdhury T, Venkatraghavan L. Central Neurogenic Hyperventilation and Hyperlactatemia After Resection of a Fourth Ventricle Tumor: A Case Report. A A Pract. 2022; 16: e01585.
[9] Park E, Kim H, Lim BG, Lee DK, Chung D. Central hyperventilation syndrome due to massive pneumocephalus after endoscopic third ventriculostomy: a case report. Korean Journal of Anesthesiology. 2016; 69: 409-12.
[10] Saito J, Amanai E, Hirota K. Dexmedetomidine-treated hyperventilation syndrome triggered by the distress related with a urinary catheter after general anesthesia: a case report. JA Clin Rep. 2017; 3: 22.
[11] Tomioka S, Takechi M, Ohshita N, Nakajo N. Propofol is not effective for hyperventilation syndrome. Anesthesia and Analgesia. 2001; 92: 781-2.
[12] Bansal T, Hooda S. Hyperventilation syndrome after general anesthesia: Our experience. J Anaesthesiol Clin Pharmacol. 2016; 32: 536-7.
[13] Thapa P, Subedi A, Poudel A, Baral P. A case of hyperventilation leading to apnea and desaturation in PACU. BMC Anesthesiol. 2019; 19: 152.
[14] Folgering H, Cox A. Beta-blocker therapy with metoprolol in the hyperventilation syndrome. Respiration. 1981; 41: 33-8.
[15] Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001; 14: 13-21.
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  • APA Style

    Liu Zhang, Xuejie Li. (2023). Hyperventilation Syndrome After Strabismus Surgery - A Case Report. International Journal of Anesthesia and Clinical Medicine, 11(1), 35-37. https://doi.org/10.11648/j.ijacm.20231101.18

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    ACS Style

    Liu Zhang; Xuejie Li. Hyperventilation Syndrome After Strabismus Surgery - A Case Report. Int. J. Anesth. Clin. Med. 2023, 11(1), 35-37. doi: 10.11648/j.ijacm.20231101.18

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    AMA Style

    Liu Zhang, Xuejie Li. Hyperventilation Syndrome After Strabismus Surgery - A Case Report. Int J Anesth Clin Med. 2023;11(1):35-37. doi: 10.11648/j.ijacm.20231101.18

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  • @article{10.11648/j.ijacm.20231101.18,
      author = {Liu Zhang and Xuejie Li},
      title = {Hyperventilation Syndrome After Strabismus Surgery - A Case Report},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {11},
      number = {1},
      pages = {35-37},
      doi = {10.11648/j.ijacm.20231101.18},
      url = {https://doi.org/10.11648/j.ijacm.20231101.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.18},
      abstract = {Hyperventilation syndrome (HVS) mainly occurs in patients under anxiety and stress and is marked by rapid, excessive breathing, resulting in respiratory alkalosis and subsequent hypocalcemia and hypokalemia, causing various physical symptoms, like numbness or tingling sensation, overactive reflexes, muscle cramps, twitches, and in severe cases, acute myocardial infarction or even death, requiring immediate diagnosis and medical intervention. We report a rare case of HVS after strabismus surgery under local anesthesia. The patient is a healthy 31-year-old woman with no psychiatric or other diseases in the past medical history. At the end of the procedure, as soon as the surgeon uncovered the sheet, the patient complained about numbness in the lower limbs, spasm in the upper limbs, muscle rigidity, and double vision. At that time, the electrocardiogram monitoring showed normal blood pressure, heart rate, pulse oxygen saturation, and breathing rate. However, the patient was awake and extremely nervous. Emergency arterial blood gas analysis (ABG) was performed immediately and revealed respiratory alkalosis with significantly reduced PaCO2 and secondary hypocalcemia and hypokalemia. Verbal reassurance, closed-mask inhalation, and electrolyte supplement were administered. HVS gradually subsided. In this context, a prompt differential diagnosis and a high degree of suspicion are essential. Monitoring end-tidal carbon dioxide may also aid in the early detection of HVS, as changes in breathing rate and pattern may be observed before definite signs and symptoms manifest in patients with HVS. However, since surgical drapes and trays cover the torso, detecting any changes in breathing rate and pattern during the surgery may be challenging. This article describes a case of HVS after strabismus surgery under local anesthesia and provides a summary of the occurrence, manifestation, diagnosis, and treatment of HVS. It is hoped that this article will facilitate the prompt identification and appropriate treatment of HVS, thereby preventing any potential negative outcomes for the patients. Additionally, HVS is a rare complication during the perioperative period and has only been reported in a small number of case reports. Therefore, further research is needed to confirm the effectiveness of measures for prevention and treatment mentioned in the text.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Hyperventilation Syndrome After Strabismus Surgery - A Case Report
    AU  - Liu Zhang
    AU  - Xuejie Li
    Y1  - 2023/05/17
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ijacm.20231101.18
    DO  - 10.11648/j.ijacm.20231101.18
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 35
    EP  - 37
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20231101.18
    AB  - Hyperventilation syndrome (HVS) mainly occurs in patients under anxiety and stress and is marked by rapid, excessive breathing, resulting in respiratory alkalosis and subsequent hypocalcemia and hypokalemia, causing various physical symptoms, like numbness or tingling sensation, overactive reflexes, muscle cramps, twitches, and in severe cases, acute myocardial infarction or even death, requiring immediate diagnosis and medical intervention. We report a rare case of HVS after strabismus surgery under local anesthesia. The patient is a healthy 31-year-old woman with no psychiatric or other diseases in the past medical history. At the end of the procedure, as soon as the surgeon uncovered the sheet, the patient complained about numbness in the lower limbs, spasm in the upper limbs, muscle rigidity, and double vision. At that time, the electrocardiogram monitoring showed normal blood pressure, heart rate, pulse oxygen saturation, and breathing rate. However, the patient was awake and extremely nervous. Emergency arterial blood gas analysis (ABG) was performed immediately and revealed respiratory alkalosis with significantly reduced PaCO2 and secondary hypocalcemia and hypokalemia. Verbal reassurance, closed-mask inhalation, and electrolyte supplement were administered. HVS gradually subsided. In this context, a prompt differential diagnosis and a high degree of suspicion are essential. Monitoring end-tidal carbon dioxide may also aid in the early detection of HVS, as changes in breathing rate and pattern may be observed before definite signs and symptoms manifest in patients with HVS. However, since surgical drapes and trays cover the torso, detecting any changes in breathing rate and pattern during the surgery may be challenging. This article describes a case of HVS after strabismus surgery under local anesthesia and provides a summary of the occurrence, manifestation, diagnosis, and treatment of HVS. It is hoped that this article will facilitate the prompt identification and appropriate treatment of HVS, thereby preventing any potential negative outcomes for the patients. Additionally, HVS is a rare complication during the perioperative period and has only been reported in a small number of case reports. Therefore, further research is needed to confirm the effectiveness of measures for prevention and treatment mentioned in the text.
    VL  - 11
    IS  - 1
    ER  - 

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Author Information
  • Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China

  • Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China

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