A Case Report of Delayed Post-operative Angioedema Associated With Angiotensin-Converting Enzyme Inhibitor Use

Abstract

Angiotensin-converting enzyme inhibitors are known to precipitate angioedema. Drug-induced angioedema is rare in the perioperative setting. Even fewer cases described hours following a minor procedure. In this case report, we present a 45-year-old female who developed drug-induced angioedema hours following an obstetric procedure.

Severe Laryngeal Edema After Extubation with Prior Use of ACEi Medications

“…The patient’s symptoms presented in the immediate post-operative period, and recent airway manipulation has been reported to precipitate AE. 5 , 9 …”

“…The patient's symptoms presented in the immediate post-operative period, and recent airway manipulation has been reported to precipitate AE. 5,9 Inciting factors often are idiopathic, yet 38%-68% of acquired forms arise following the use of ACEis, which interfere with the conversion of angiotensin I to angiotensin II and cause a reduction in the degradation of bradykinin. 3,6,8 Other medications include certain antibiotics, opioids, 7 NSAIDs, 10,11 and angiotensin II receptor antagonists.…”

“…In patients with hoarseness, odynophagia, or dyspnea, fiberoptic nasopharyngolaryngoscopy can be a useful technique to evaluate for laryngeal edema. 5,7 This case reports a patient with a previous history of ACEi use who presented with severe laryngeal edema 20 minutes following extubation. Multiple attempts at reintubation were made utilizing an awake Glidescope™ technique, fiber optic, and blind nasal tube placement.…”

“…In patients with hoarseness, odynophagia, or dyspnea, fiberoptic nasopharyngolaryngoscopy can be a useful technique to evaluate for laryngeal edema. 5 , 7 …”

“…Among patients presenting with AE, facial edema was seen in 85%, followed by lingual swelling in 40% and laryngeal edema in 10%; the condition is self-limiting, with spontaneous resolution of swelling often within two to three days. [4][5][6] Immediate management of AE focuses on airway protection, as respiratory failure may ensue secondary to airway edema and complete obstruction. In patients with hoarseness, odynophagia, or dyspnea, fiberoptic nasopharyngolaryngoscopy can be a useful technique to evaluate for laryngeal edema.…”