Angioneurotic edema of upper airway tissues due to angiotensin converting enzyme inhibitor (ACEI) usage is a known perioperative complication of this class of medications. Swelling can begin rapidly, and typically involves the tongue and oral cavity. We have recently encountered four cases in which supraglottic edema developed after onset of tongue swelling and progressed despite resolving tongue edema. We present a representative case. This observation suggests that all patients with ACEI-induced angioedema should undergo laryngeal fiberoptic examination and appropriate airway management.

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