Anesthesia for Unilateral Lung Lavage in a Patient with Pulmonary Alveolar Proteinosis: A Case Report

Background: Pulmonary alveolar proteinosis (PAP) was first described in 1958. Basically, PAP is caused by an impairment of surfactant clearance or abnormal surfactant production, according to various pathogenetic mechanisms and different etiologies. In 90% of cases, it is an autoimmune disease compromising immunoglobulin (Ig)-G and anti-GM-CSF. The objective of this report is to show a case of a patient with severe PAP who was admitted to the emergency room with dyspnea and chest pain and was followed up by the pulmonology outpatient clinic and indicated for pulmonary lavage. Case Report: A 38-year-old female patient, weighing 95 kg and measuring 155 cm tall, with dyspnea and chest pain with intensity 6/10 for 9 months, which had worsened for 3 months. Admitted to the emergency room with dyspnea, asthenia and chest pain. Diagnosis of PAP is performed through laboratory and imaging tests, with pulmonary lavage under intravenous general anesthesia being indicated. During right pulmonary lavage, 14 liters of warmed saline solution were infused, and 13.6 liters of fluid were drained, lasting 4 hours and resulting in a marked improvement in the symptoms, with the patient being extubated in the ICU 12 hours after the end of the procedure. Conclusion: Pulmonary alveolar proteinosis is a rare disease that requires special attention during procedures such as whole lung lavage. Anesthetic management presents unique challenges, especially in patients with low pulmonary reserve and risk of hypoxemia, as observed in the reported case.