Sivelestat Improved Oxygenation in a Patient Who Suddenly Developed Hypoxia During Surgical Resection of Perforated Colon - Abstract
Sivelestat is a potent inhibitor of neutrophil elastase activity. We report a patient who suddenly developed hypoxia during surgery, which improved by the administration of sivelestat. A 72-year-old woman underwent emergency resection of a perforated colon that was capsulated by mesenterium. During the surgical manipulation, the capsule ruptured, causing spillage of dirty discharge into the abdominal space. A few minutes after it ruptured, her oxygen saturation (SpO2) suddenly dropped from 100% to 94%. Ten minutes after it ruptured, administration of sivelestat, 12 mg/hr, was started. Her SpO2 gradually increased and her Arterial Blood Gas (ABG) values improved. After the surgery, the patient was admitted to the Intensive Care Unit (ICU). Her trachea was extubated 30 hours after admission to the ICU. There were no remarkable pulmonary complications after extubation. Sivelestat administration was continued for four days. The time course of oxygen desaturation and her blood parameters suggested that systemic circulation of an endotoxin induced the secretion of elastase from neutrophils, which in turn caused sudden desaturation. If the patient had not been treated with sivelestat, there was a high possibility that she could have developed Acute Lung Injury (ALI) due to the hypoxia. When a patient with risk factors for developing ALI develops oxygen desaturation during surgery, administration of sivelestat may improve the patient’s oxygenation and prevent the development of ALI.