Alternating Pseudohemoptysis and Hematemesis during Recovery after General Anesthesia - A case report -

A 22-year-old male patient was admitted for reconstructive surgery after primary orbital fracture operation. Following uneventful intraoperative procedure except postextubation laryngospasm, in PACU area, there were alternately frustrating and confusing events of several times of projectile vomiting of considerable amount of dark blood and hemoptysis with forceful coughing. On rigid nasal endoscopic examination after investigative gastric endoscopy and bronchoscopy, intranasal bleeding at the point of the middle turbinate was found, highly suggestive of anterior ethmoidal artery injury during the operation. Presumably blood swallowing with restoration of spontaneous respiration during emergence and aspiration after extubation resulted in these different features of hematemesis and pseudohemoptysis, respectively. In conclusion, one must keep in mind the potentially dangerous but preventable swallowing and aspiration during the course of emergence and recovery after general anesthesia for surgery or accompanying injury of orofacial structures. (Korean J Anesthesiol 2008; 54: 585∼8)