Just thought I would share a case that I had.

78 year old having cataract surgery under topical anesthesia. She had the left eye done 2 weeks ago and is having her right eye today. Patient gets 2 mg IV versed during the case. She also has diamox 500 mg infused during the case per surgeon orders.

Not long after the case began she started to cough occasionally. The surgeon would have to stop and wait for the coughing spell to pass and would then continue with the surgery. As surgery progressed her BP drifted down from 130 sys to 80. Her SaO2 went from 99% on 3L/nc to about 90% towards the end of surgery. I gave her a little fluid bolus (500 ml) to see if her BP would respond, but it continued to drop so I started to treat with neo/ephedrine. Now surgery is over and her O2 sat is in the low 80's on a NC. I can get her up to 90% on a NRB face mask. Can't sit her up because her BP will not tolerate it.

I took her to the recovery room and we got a 12 lead which showed normal sinus rhythm. Her chest x ray showed what looked like pulmonary edema. Her lungs sounded "wet" on auscultation. I put in a CVL and an a-line,(I'm thinking, "[B]All this for a freaking cataract![/B]) consulted the hospitalist, put her on bipap, and started her on levophed for BP control. CVP was 4. An echo done in recovery was unremarkable. Initial troponin was negative.

What do you think caused all of this?