Post Extubation Bronchospasm in an Undiagnosed Case of Ascariasis: Anaesthetic Challenges

Abstract

A 40-year-old man reported to the emergency with sudden pain in abdomen early morning. Pain was generalized and increasing in severity. His personal and past history was insignificant with no history of Upper respiratory tract infection, asthma and chronic obstructive pulmonary disease. All routine investigations were within normal range. Quick pre anaesthetic examination was not significant. His vitals were B.P 130/88 mmHg, Pulse rate 98/min, Respiratory rate 20 min, SpO 2 96% on air, without any significant auscultatory findings. Patient was taken in emergency operation theatre for exploratory laparotomy.After securing two large bore 18G peripheral intravenous cannula and placement of nasogastric tube, routine premedication was given as per institutional protocol. General anaesthesia was then induced and maintained throughout the course. During exploration a small perforation (0.5 × 0.5 cm 2 ) was found in the first part of the duodenum A live adult round worm [Table/ Fig-1] came out through the perforation, which was stored in sample collection bottle and sent for microbiology department. Perforation was repaired and skin sutures were secured. After achieving adequate muscle power and respiration, patient was successfully extubated. While patient was still on O.T table, he developed sudden respiratory distress with RR 28/min, fall in saturation gradually till 80% with added expiratory wheeze. Bag and mask ventilation was done with 100% FiO 2 but SpO 2 further decreased to 60% with RR 40 per min, B.P 140/90 mmHg and PR 100/min. Patient was reintubated after giving propofol and supplemented with deriphyllin, hydrocortisone, dexamethasone intravenously. After ventilating with Bain's circuit with 100% FiO 2 gradually SpO 2 increased till 90% and then patient was shifted to Surgical intensive care unit where he was given oxygen (FiO 2 100%) through T piece. After half an hour he was able to maintain SpO 2 to 98% (FiO 2 40%), RR 16/ min, B.P 120/76 mmHg, PR 78/min and bilateral equal air entry ABSTRACTOne of the most prevalent parasitic infestation is ascariasis which poses a great challenge to both the person being infested with and the treating medical team. We present here a case of round worm (Ascaris lumbricoides) infestation. A 40-year-old male, weighing 60 kg, diagnosed as perforation peritonitis, was scheduled for emergency exploratory laparotomy. The round worm was crawling out from duodenal perforation vent during laparotomy confirming the infestation. Patient later developed bronchospasm in postextubation period and was managed accordingly. Surprisingly the patient expelled an adult worm in the next morning. This report highlights the importance of anticipating complications (i.e., airway obstruction, bronchospasm, etc.,) in an undiagnosed case of round worm infestation, especially if routine investigations were within normal limits.on auscultation with no added sounds. He was then extubated and watched for any other complications. In the morning next day patient expelled an adult Ascaris worm [Table/ F...