Cheyne-Stokes Respiration Recognized at the Awakening Stage from Anesthesia

A 65-year-old male with chronic renal failure underwent removal of an inserted tube for continuous ambulatory peritoneal dialysis because of infectious peritonitis. Preoperative examinations revealed severe congestive heart failure with the cardiothoracic ratio of 63% and the ejection fraction of 26%. The patient was in a drowsy state and was annoyed with persistent hiccups. Surgery was completed uneventfully under the combination of regional and inhalation anesthesia. The authors noticed appearing of Cheyne-Stokes respiration (CSR) in the patient while he was recovering from anesthesia. The patient repeated respiration and apnea periods alternately. Respiratory movements in the respiration period were not regular, but waxed and waned. Pulse oximetry indicated fluctuations of arterial oxygen saturation corresponding with the periodicity of respiratory movements. The arterial oxygen saturation took the minimum value immediately before the start of the respiration period and the maximum value at the turning point from waxing to waning in the respiration period. The minimum value was 93% under oxygen inhalation and 75% under room air inhalation. After surgery, clinical symptoms of peritonitis subsided and the laboratory data indicated that acute inflammation had improved. Then, CSR disappeared and normal rhythmic respiration returned. Postoperative cerebral examinations disclosed diffuse atrophy of the brain and extensive stenosis of the cerebral arteries. It is most likely that infectious peritonitis worsened the preexisting heart failure and insufficient cerebral circulation, resulting in the development of CSR as a sign of cerebral dysfunction.