A rare case of angioedema after anaesthesia

Case Report: Post-operative Angioedema After a Laryngeal Mask Airway Application

“…In majority of cases, it remains self-limited and will only require supportive therapy with monitoring. However, in 11% of cases airway intervention is required to save the patient ( 1 ). In such patients, the mortality can be as high as 30–40% ( 3 ).…”

“…Other factors linked to bradykinin-mediated AE include treatment with angiotensin 2 receptor antagonists, non-steroidal anti-inflammatory drugs, latex allergy, surgical stress, and oropharyngeal instrumentation, including laryngoscopy ( 1 ). The principal therapy is discontinuation of the offending drug and oxygenation ( 9 ).…”

“…Propofol is known to temporarily increase local bradykinin levels, which is the mechanism of pain at injection site. Even though the effect is transient, and the half-life of bradykinin is only 15 s ( 1 ), the capillary leak and edema may have a much longer duration. Propofol, in conjunction with surgical stress and mechanical manipulation during intubation, may contribute to edema formation in susceptible patients.…”

“…Angioedema (AE) or Quincke's edema is an acute-onset transient edema involving the skin, subcutaneous tissues, and mucous membranes of the face, oral cavity, airway structures or the gastrointestinal tract, the upper and lower extremities (1)(2)(3)(4)(5). The underlying mechanisms include histamine and inflammatory cytokine release, overproduction or decreased degradation of bradykinin, or a hereditary C1 esterase inhibitor deficiency: a rare disease with autosomal dominant inheritance (1,4). AE related to histamine release presents as an allergic reaction of an immediate type triggered by IgE-mediated release of histamine and other mediators by mast cells and basophils.…”

“…Cases of AE with increased levels of bradykinin are generally associated with use of specific medications: angiotensin converting enzyme (ACE) inhibitors, angiotensin 2 receptor antagonists, non-steroidal anti-inflammatory medications, and other drugs, including propofol, which increase bradykinin levels in tissues (1,3,4,(6)(7)(8)(9). According to Ishoo E. and co-authors, ACE inhibitors are the most common cause of drug-induced AE representing 25-39% of cases (4).…”