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

Soghomonyan, Suren; Fleming, Qian; Bhandary, Sujatha

doi:10.3389/fmed.2021.566100

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…Airway patency is to be monitored to ensure patient oxygenation, which in 11% of the cases there are risk of hypoxia needed for prompt intervention such as surgical tracheostomy and in turn increases mortality as high as 30-40%, morbidity and length of hospital stay. [1] 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 gastrointestinal tract, the upper and lower extremities. The mechanisms causing this reaction are mainly divided into two; mast cell-mediated and bradykinin-mediated.…”

Section: Discussion / Conclusionmentioning

confidence: 99%

“…3 Effective medication included epinephrine, glucocorticoids, antihistamine and oxygen. [1,4]This patient was administered Diphenhydramine and Methylprednisolone as empiric therapy, with justification that there was possibility of deterioration of the respiratory function.…”

Section: Discussion / Conclusionmentioning

confidence: 99%

“…Propofol may increase bradykinin levels in tissues, typically occurred local to the site of injection such as transient burning sensation during drug administration. [1]Factors contributing to incidence of AE related to propofol include pain, anxiety, significant physical and surgical stress, infection and temperature changes. Propofol associated AE typically develop immediately following injection, with more than 90% ot the reactions occur within 5 minutes of administration.…”

Section: Discussion / Conclusionmentioning

confidence: 99%

“…Propofol, in conjunction with surgical stress may contribute to AE formation in this patient. [1]Examination that may aid in diagnosis includes tryptase test, skin prick test and intradermal test. [10]In remote area, oftentimes a final diagnosis cannot be established, and symptomatic therapy to stabilize the patient become a priority.…”

Section: Discussion / Conclusionmentioning

confidence: 99%

See 3 more Smart Citations

A Case of Neurovascular Edema Induced by Propofol

2022

JCMP

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One life threatening manifestation of drug hypersensitivity is angioedema. In some rare cases, propofol may induced angioedema and is proposed to be allergy related. This case report presented a case of angioedema induced by propofol administration in remote area. Limited resources available added another challenge in confirming diagnosis and treating the disease. Nevertheless, identifying and discontinuing the suspected etiology should not be postponed and monitoring intensively should be initiated early to prevent lethal condition.

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Section: Discussion / Conclusionmentioning

confidence: 99%

Section: Discussion / Conclusionmentioning

confidence: 99%

Section: Discussion / Conclusionmentioning

confidence: 99%

Section: Discussion / Conclusionmentioning

confidence: 99%

See 2 more Smart Citations

A Case of Neurovascular Edema Induced by Propofol

2022

JCMP

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“…Early exclusion of angioedema is important as this may worsen swelling of tissues and cause acute airway obstruction. 2,3…”

Section: Discussionmentioning

confidence: 99%

Acute bilateral parotid swelling upon laryngeal mask airway insertion: A case report

Wong

Guise

2022

Anaesth Intensive Care

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We describe a case of bilateral parotid swelling developing shortly after laryngeal mask airway insertion. Spontaneous resolution occurred within 12 h postoperatively This unusual phenomenon has been termed ‘anaesthesia mumps’ or ‘acute sialadenosis’. Its exact relationship to anaesthesia remains unknown. It arises in a variety of patients and surgeries, making its pathogenesis difficult to determine. Its presentation can be confused with acute angioedema, but, unlike the latter, it is benign and not normally associated with airway compromise. Diagnosis is a process of exclusion, but careful airway assessment is an important component of this. Strategies to aid diagnosis and management are described.

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Lisinopril

2021

Reactions Weekly

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Post-operative angioedema presenting as macroglossia: case reportA 71-year-old man developed post-operative angioedema (AE) presenting as macroglossia during treatment with lisinopril for arterial hypertension.The man with a past medical history of coronary arterial disease, atrial flutter, ascending thoracic aortic dissection repair, aortic and mitral valve repair, three-vessel coronary bypass, arterial hypertension and bifascicular block, was scheduled for an elective soft tissue biopsy of the ankle with possible resection and evacuation of the accumulated blood. He had no known history of allergies, complications of anaesthesia or any family history of angioedema. He had been receiving lisinopril [route and dosage not stated] and various other concomitant medications. Following preoxygenation, anaesthesia was induced with propofol and lidocaine followed by placement of a laryngeal mask airway without any difficulty. He was then placed in right lateral position, and surgery was started. General anaesthesia was maintained with sevoflurane in a mixture of oxygen with air. Throughout the surgery, he received ketamine and his BP was supported with phenylephrine. No antibiotics were administered during the surgery. At the end of surgery, ondansetron was administered as an antiemetic. The procedure was completed uneventfully with evacuation of collected blood and soft tissue biopsy, the laryngeal mask airway was removed, and he was transferred to the post-operative recovery unit. A routine inspection of the oral cavity at the time of the laryngeal mask airway removal did not reveal any trauma to the mucosa or local oedema. In an hour after the surgery, he developed swelling of the tongue. Immediate assessment revealed a progressively worsening swelling on the left half of the tongue without any airway compromise. Haemodynamic and respiratory parameters were found to be within the normal limits. In around an hour, the whole tongue became swollen without signs of respiratory distress. A preliminary diagnosis of AE possibly due to lisinopril was made. As alternative diagnoses, IgE-mediated anaphylactic reaction and macroglossia as a result of the LMA application and patient positioning were considered even though with lower possibility.The man received treatment with dexamethasone and diphenhydramine [Benadryl]. Oxygen inhalation was also started. He was observed overnight. An endoscopic examination revealed isolated oedema of the tongue without airway compromise, trauma or haematoma. A tryptase test was subsequently performed and was found to be negative. With conservative management and observation, his condition improved with complete resolution of the oedema within 24h. No additional laboratory tests were ordered (measurement of C1 estherase inhibitor activity and the C4) at that time. He was uneventfully discharged from the hospital next morning after an overnight observation. While in the hospital, lisinopril therapy was discontinued. He was referred to his primary care practitioner for further treatment and possi...

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

Cited by 5 publications

References 12 publications

A Case of Neurovascular Edema Induced by Propofol

A Case of Neurovascular Edema Induced by Propofol

Acute bilateral parotid swelling upon laryngeal mask airway insertion: A case report

Lisinopril

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