Austin Journal of Anesthesia and Analgesia

International Journal of Research in Medical Sciences, 2018

Acute pulmonary edema post extubation due to negative pressure with laryngospasm in the early postoperative period has been reported and may occur at any time during anesthesia. The usual treatment consists of respiratory support and diuretics. We present the clinical case of a 15-year-old patient who underwent laparoscopic appendectomy, who presented acute non-cardiogenic pulmonary edema in the postoperative period. This complication can be presented in any surgical patient intubated, so it is important to know the pathophysiological basis to be able to diagnose and treat this pathology.

Negative pressure pulmonary edema after orotracheal extubation in emergency surgery (Atena Editora), 2023

The objective is to report the case of a patient undergoing emergency partial colectomy due to acute perforative abdomen who developed negative pressure pulmonary edema after orotracheal extubation. Information was obtained through chart review, patient interview, photographic record of diagnostic methods, and literature review. MLR, 37 years old, male, previously healthy, admitted to the hospital complaining of abdominal pain. He was admitted to the operating room for laparotomy due to a diagnosis of pneumoperitoneum. Anesthetic induction was uneventful. Intraoperatively, the parameters remained stable. At the end, anesthetic weaning and extubation were performed. The patient evolved with superficial respiration and use of accessory muscles, with a rapid decrease in peripheral saturation. Based on intraoperative normality parameters, employed protective ventilation and altered auscultation, acute pulmonary edema due to negative pressure was identified. Positive pressure ventilation was performed using a face mask, with increased saturation and improvement of respiratory pattern. Ventilation was necessary until the patient ceased discomfort and remained stable with oxygenation through nasal catheter. Despite being a well-described clinical entity, this is a little known complication. Early identification and appropriate treatment are essential for clinical outcome.

Critical Care, 2009

Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality. Incidence Although laryngeal edema occurs in nearly all intubated patients, only some of them develop clinical symptoms. Laryngeal edema is therefore usually transient and self-limiting. Clinical signs associated with laryngeal edema develop

Anesthesiology, 2010

2011

An important cause of pulmonary oedema is Negative Pressure Pulmonary Oedema (NPPE) which characteristically develops soon after extubation from an endo-tracheal intubation. In this case report we identified a case of previously healthy man who was intubated for General Anaesthesia for extraction of impacted molar tooth. Soon after extubation he developed severe respiratory distress. Immediate diagnosis of NPPE secondary to post extubation laryngospasm was made. He was promptly treated with 100 percent oxygen via CPAP (continuous positive airway pressure) mask and within an hour he markedly improved and subsequently became asymptomatic.

Medical Journal Armed Forces India, 2012

Journal of Oral and Maxillofacial Surgery, 1995

Respiratory medicine, 2008

We report a series of patients with postextubation pulmonary edema who had no obvious risk factors for the development of this syndrome. Patients identified by the pulmonary consultation service at an academic medical center were reviewed. Fourteen cases were collected and analyzed. The average age was 34.5 years; 12 patients were male. The average BMI was 25.5. None had documented previous lung disease. Most operations were scheduled as outpatient procedures, and the type of surgery ranged from an incision and drainage of a bite wound to an open reduction-internal fixation of the radius. None of the patients had upper airway surgery. The length of surgeries ranged from 27 to 335 min. Laryngospasm was the most commonly identified obstructing event postextubation. Treatment involved airway support when needed, supplemental oxygen, and diuretics. It would appear that all patients, especially young men, are at risk for the development of this syndrome and that the pathogenesis remains ...

Critical Care, 2015

Endotracheal intubation is frequently complicated by laryngeal edema, which may present as postextubation stridor or respiratory difficulty or both. Ultimately, postextubation laryngeal edema may result in respiratory failure with subsequent reintubation. Risk factors for postextubation laryngeal edema include female gender, large tube size, and prolonged intubation. Although patients at low risk for postextubation respiratory insufficiency due to laryngeal edema can be identified by the cuff leak test or laryngeal ultrasound, no reliable test for the identification of high-risk patients is currently available. If applied in a timely manner, intravenous or nebulized corticosteroids can prevent postextubation laryngeal edema; however, the inability to identify high-risk patients prevents the targeted pretreatment of these patients. Therefore, the decision to start corticosteroids should be made on an individual basis and on the basis of the outcome of the cuff leak test and additiona...

The Internet Journal of Anesthesiology, 2007

Negative pressure pulmonary edema is a potentially life-threatening complication especially during emergence in patients undergoing general anesthesia for a variety of surgical procedures. Laryngospasm-mediated upper airway obstruction leads to forced inspiration generating excessive negative intrathoracic pressure and causes negative pressure pulmonary edema. However the symptoms may also develop late in the postoperative period. We describe two young, strong men who developed this clinical picture at different times following routine uncomplicated surgical procedures. This paper not only reports the importance of early recognition of this potentially serious complication for anesthesiologists but also serves as a reminder to physicians caring for postanesthesia patients in the surgical ward to prevent the delay in diagnosis and significant morbidity.