A patient, in her mid-twenties, presented with "severe polypoid
sinusitis" for sphenoethmoidectomy under
general anesthesia. Upon preoperative medical evaluation, it was discovered that she was "allergic" to
aspirin and suffered from stress-induced
asthma. Before induction of
anesthesia, the patient was administered intravenous
hydrocortisone and two puffs of her
albuterol inhaler to prevent a possible
bronchospasm due to stress of the surgery or irritation from the endotracheal tube or other stimuli. The patient was maintained throughout the case with an
inhalation anesthetic for its bronchodilatory effect. The surgery proceeded unremarkably, and the patient was then administered
ketorolac tromethamine for
postoperative pain. After an awake extubation, the patient was transferred to the postanesthesia care unit (PACU) for further monitoring. After 15 min in the PACU, the patient claimed having difficulty breathing. She was then administered
terbutaline to produce bronchodilation, but her condition did not improve. Shortly thereafter,
aminophylline,
midazolam, and
methylprednisolone were also administered intravenously. Meanwhile, the patient had to be reintubated and placed on
ventilator support with heavy sedation. At this point, it was discovered that
ketorolac may have been the cause of this response. Although the patient's condition began to improve, the
histamine H1- and H2-receptor blockers
diphenhydramine and
ranitidine were coadministered. When the patient's condition returned toward normal, she was extubated. The patient's breathing continued to improve. Thereafter, she was transferred to an overnight observation bed and later dismissed to return home. The patient was advised of the episode and warned against future intake of other nonsteroidal antiinflammatory drugs.