Sevoflurane-Induced Diffuse Alveolar Hemorrhage

Mohammad Ahmed-Khan, Kayvon Moin, Carly Funk, Mala Sachdev, Mohamed Zakee Mohamed Jiffry


Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary pathology which results in intra-alveolar hemorrhage secondary to disruption of the alveolar capillary basement membrane. Most commonly, these patients present with hemoptysis, hypoxemia and pulmonary infiltrates. Although rare, sevoflurane, an inhalational anesthetic used as a rapid induction agent for anesthesia may be implicated in the etiology of DAH. We report a case of a 21-year-old otherwise healthy male found to have postoperative diffuse alveolar hemorrhage secondary to sevoflurane inhalation. Thus far, only five documented cases describing sevoflurane induced diffuse alveolar hemorrhage have been described in the literature, with prior cases also showing a clear temporal association between sevoflurane administration and symptom onset. Although uncommon, we must take sevoflurane into consideration as a possible etiology of diffuse alveolar hemorrhage when encountering signs of respiratory distress and hemoptysis in postoperative patients.


Sevoflurane; Anesthesia; Diffuse Alveolar Hemorrhage; Respiratory Distress; Critical Care

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De Hert S and Moerman A. Sevoflurane [version 1; peer review: 2 approved]. F1000Research 2015, 4(F1000 Faculty Rev):626 (

Miller AL, Theodore D, Widrich J. Inhalational Anesthetic. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32119427.

Behne M, Wilke HJ, Harder S. Clinical pharmacokinetics of sevoflurane. Clin Pharmacokinet. 1999;36(1):13-26. doi: 10.2165/00003088-199936010-00002. PMID: 9989340.

Gonsowski CT, Laster MJ, Eger EI 2nd, Ferrell LD, Kerschmann RL. Toxicity of compound A in rats. Effect of increasing duration of administration. Anesthesiology. 1994;80(3):566-573. doi: 10.1097/00000542-199403000-00013. PMID: 7908177.

Shayevitz JR, Traystman RJ, Adkinson NF, Sciuto AM, Gurtner GH. Inhalation anesthetics augment oxidant-induced pulmonary vasoconstriction: evidence for a membrane effect. Anesthesiology. 1985;63(6):624-632. doi: 10.1097/00000542-198512000-00012. PMID: 3933385.

Fatheree RS, Leighton BL. Acute respiratory distress syndrome after an exothermic Baralyme-sevoflurane reaction. Anesthesiology. 2004;101(2):531-533. doi: 10.1097/00000542-200408000-00034. PMID: 15277936.

Wu J, Previte JP, Adler E, et al. Spontaneous ignition, explosion, and fire with sevoflurane and barium hydroxide lime. Anesthesiology. 2004;101(2):534-537. doi: 10.1097/00000542-200408000-00035. PMID: 15277937.

Khanna AK, Cummings KC 3rd. Pulmonary hemorrhage in an outpatient ophthalmic anesthesia setting - it's never "just a cataract". J Anaesthesiol Clin Pharmacol. 2012;28(4):520-523. doi: 10.4103/0970-9185.101947. PMID: 23225939; PMCID: PMC3511956.

Kim CA, Liu R, Hsia DW. Diffuse alveolar hemorrhage induced by sevoflurane. Ann Am Thorac Soc. 2014;11(5):853-855. doi: 10.1513/AnnalsATS.201402-067LE. PMID: 24936702.

Mersh R, Ross C. Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced? BMJ Case Rep. 2018; 2018:bcr2017222010. doi: 10.1136/bcr-2017-222010. PMID: 29991540; PMCID: PMC6047713.

Cengiz O, Kivrak A, Yegen M, Demir M. Sevoflurane induced diffuse alveolar haemorrhage in a young patient after orthopedic surgery: A case report. Niger J Clin Pract. 2020;23(1):120-122. doi: 10.4103/njcp.njcp_51_19. PMID: 31929218.

Austin A, Modi A, Judson MA, Chopra A. Sevoflurane Induced Diffuse Alveolar Hemorrhage in a young patient. Respir Med Case Rep. 2016;20:14-15. doi: 10.1016/j.rmcr.2016.11.001. PMID: 27872805; PMCID: PMC5107734.


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