Introduction:
Diffuse alveolar haemorrhage (DAH) is a rare, life-threatening condition characterised by haemoptysis, hypoxaemia, and respiratory failure. Aetiologies are diverse and include negative-pressure pulmonary oedema secondary to upper airway obstruction. While obstructive sleep apnoea (OSA) is a common cause of intermittent upper airway obstruction in children, DAH associated with OSA is rarely reported. We present a case of DAH occurring during induction of anaesthesia in a child with severe OSA.
Methods:
A 7-year-old boy with obesity, autism spectrum disorder, and severe OSA was admitted for sleep nasendoscopy and revision adenotonsillectomy. Dexmedetomidine was administered preoperatively because of behavioural challenges. Following inhalational induction with sevoflurane, profound oxygen desaturation occurred. Video laryngoscopy revealed brisk haemorrhage arising from the trachea. The patient was intubated but subsequently developed pulseless electrical activity. Cardiopulmonary resuscitation was initiated, with return of spontaneous circulation achieved within one minute following chest compressions and adrenaline administration. Bronchoalveolar lavage confirmed diffuse lower airway haemorrhage. Surgery was abandoned, and the patient underwent CT angiography before transfer to the paediatric intensive care unit.
Results:
The patient was intubated and ventilated for seven days with positive-pressure support, inotropic therapy and tranexamic acid infusion. High-dose methylprednisolone was given to address the differential diagnosis of a sevoflurane-associated reaction. Revision adenoidectomy was successfully completed on day five, and the patient was extubated on day seven.
Conclusion:
DAH should be considered in children with severe OSA who develop acute respiratory compromise during anaesthetic induction. Early recognition, airway control, multidisciplinary management, and cardiorespiratory support are critical to achieving favourable outcomes.