Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy

Koide, Masaaki; Kitada, Tatsuya; Kogure, Masaya; Fukui, Kuniaki; Sogabe, Koji; Kato, Yoshio; Kitajima, Hiroki; Akabame, Satoshi

doi:10.1155/2020/8830935

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Disease progression. Cases of delayed onset are rare, but pulmonary edema has been reported to occur 1-6 h after upper airway obstruction (44,47,48). Since the severity of clinical manifestations is variable, some mild cases may not be recognized.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Negative pressure pulmonary edema (Review)

Liu

Wang

et al. 2023

Exp Ther Med

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Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. If left untreated, NPPE can lead to hypoxemia, heart failure and even shock. Furthermore, the drug treatment of NPPE remains a subject of controversy. The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. NPPE exhibits numerous risk factors and causes, with laryngospasm following anesthesia and extubation being the most prevalent. The diagnosis of NPPE often presents challenges due to confusion with conditions such as gastroesophageal reflux or cardiogenic pulmonary edema, given the similarity in initial factors triggering both diseases. Upper airway patency, positive pressure non-invasive ventilation, supplemental oxygen and re-intubation mechanical ventilation are the foundation of the treatment of NPPE. The present review aims to discuss the etiology, clinical presentation, pathophysiology and management of NPPE.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Negative pressure pulmonary edema (Review)

Liu

Wang

et al. 2023

Exp Ther Med

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“…This tremendous difference significantly reduces surgical efficiency. Second, although tracheal intubation is essential in general anaesthesia, it could also raise a series of complications (e.g., blood pressure fluctuation, postoperative hoarseness, haemorrhage, and even negative-pressure pulmonary oedema) (Koide et al 2020 ), which have a severe impact on the surgical process and the prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy

et al. 2023

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Background Vocal cord polyp is common otorhinolaryngological disease, traditionally treated by vocal cord polypectomy under a supporting laryngoscope with general anaesthesia. Although it is safe and controllable, it would cause some anaesthesia complications. Moreover, the complex process of general anaesthesia may significantly reduce surgical efficiency. Avoiding these problems remains an important issue. Methods All patients were subjected to the standard non-intubated deep paralysis (NIDP) protocol consisting of four phases. An emergency plan was launched when NIDP cannot be implemented successfully. Patient characteristics, blood gas and monitoring data were collected during NIDP. Data concerning satisfaction, complications and duration of anaesthesia and recovery were collected to assess its effectiveness. Result Among 20 enrolled patients, the success rate of NIDP was 95%. Only one patient failed in completing NIDP. Blood gas analysis revealed that the partial pressure of oxygen and carbon dioxide was maintained at safe levels. Monitoring during NIDP revealed fluctuations in mean arterial pressure between 110 and 70 mmHg, and the heart rate was stable at 60–100 beats per minute. The duration of anaesthesia and postoperative recovery were 13.0 ± 2.84 and 5.47 ± 1.97 min, respectively. All patients and surgeons were satisfied with NIDP, and no complications were detected before discharge. Conclusion NIDP can be safely applied to patients and can replace general anaesthesia in vocal cord polypectomy. It can significantly reduce the duration of anaesthesia and postoperative recovery. No anaesthesia complications occurred without intubation, and patients and surgeons were satisfied with NIDP. Trial registrations This single-centre, prospective study was registered on clinicaltrial.gov (NCT04247412) on 30th July 2020.

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Negative pressure pulmonary edema: a case report and literature review

Wu,

Yuan,

Guo

et al. 2024

Front. Med.

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Negative pressure pulmonary edema (NPPE) is a form of non-cardiogenic pulmonary edema triggered by a swift increase in negative intrapleural pressure due to upper airway obstruction and represents a potential cause of acute respiratory failure. This study documents a case of NPPE post-endotracheal extubation subsequent to general anesthesia. The patient, a young female, underwent a “laparoscopy-assisted unilateral salpingectomy” under general anesthesia for an ectopic pregnancy. Immediately post-extubation, the patient exhibited a sudden decline in oxygen saturation and tachypnea. Pink frothy secretions were suctioned from the oral and nasal cavities. Swift interventions, including oxygen therapy, non-invasive ventilation, diuretics, and corticosteroids, were administered. The patient’s condition was effectively managed, and after 6 days of treatment, she was discharged from the hospital following full recovery.

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Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy

Cited by 3 publications

References 18 publications

Negative pressure pulmonary edema (Review)

Negative pressure pulmonary edema (Review)

Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy

Negative pressure pulmonary edema: a case report and literature review

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