Difficult weaning from mechanical ventilator in a patient with corticosteroid insufficiency after low anterior resection of sigmoid colon

A 75-year-old man underwent low anterior resection for sigmoid colon cancer under general anesthesia. Comprehensive preoperative surveys showed normal cardiopulmonary functions. In spite of adequate fluid administration, persistent intraoperative hypotension required vasopressors to maintain an acceptable blood pressure. Although the patient was fully awakened from anesthesia with adequate oxygenation, repeated attempts to wean him from the ventilator failed in the postanesthesia intensive care unit, despite recovery from the effect of muscle relaxant. Low plasma cortisol level was found in a series of laboratory analyses. After supplementation with corticosteroid, the patient was successfully weaned from the mechanical ventilator without any sequelae.