Negative pressure pulmonary edema after general anesthesia

Liu, Ruizhu; Wang, Jian; Zhao, Guangyao; Su, Zhenbo

doi:10.1097/md.0000000000015389

Cited by 34 publications

(44 citation statements)

References 26 publications

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“…However, this pathogenesis is contradicted in the present cases because there were no intracranial lesions or upper airway obstructions in the perioperative period. [ 15 ] Furthermore, the patients discussed in this case study were elderly, which is not supportive of the diagnosis of negative pressure PE, which mainly occurs in relatively younger patients.…”

Section: Discussionmentioning

confidence: 86%

Postoperative pulmonary edema following vitrectomy in patients with ischemic heart disease and diastolic dysfunction in the post-anesthetic care unit

Cheong

Kim

et al. 2020

Medicine

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Rationale: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. Patient concerns: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. Diagnoses: Chest x-ray and computed tomography indicated PE. Interventions: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 μg/kg/min dobutamine was infused intravenously. Outcomes: On postoperative day 2, the patients’ vital signs were stable and there were no signs of respiratory disturbance. Lessons: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.

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Section: Discussionmentioning

confidence: 86%

Postoperative pulmonary edema following vitrectomy in patients with ischemic heart disease and diastolic dysfunction in the post-anesthetic care unit

Cheong

Kim

et al. 2020

Medicine

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“…In contrast, patients with NPPE caused by infection like epiglottitis need to obtain endotracheal intubation, cricothyroidotomy or tracheotomy [ 4 ]. The mechanical obstruction which could not be released by positive pressure, such as foreign body and postoperative tracheal stenosis, also must be introduced with invasive airway protection including endotracheal intubation, because the secure airway opening was the first step of treatment [ 10 ]. Therefore, if airway obstruction causing NPPE is not recognized promptly, prognosis of patients might be miserable and fatal [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Negative pressure pulmonary edema related with severe sleep apnea syndrome: A case report

Watanabe

Nagata

Ichige

et al. 2020

Respiratory Medicine Case Reports

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Negative pressure pulmonary edema (NPPE) caused by airway obstruction was often life-threatening. Major cause of NPPE in adult patients was reported as post-operative laryngospasm. Therefore, NPPE was recognized widely among surgeons and anesthesiologist, but physicians also could face NPPE case in several clinical situation. NPPE in this case was caused by sleep apnea syndrome (SAS) as relatively rare cause. A 65-year-old female presented to emergency department due to disturbance of consciousness during sleep. This patient had desaturation requiring oxygen administration. Computed tomography showed pulmonary edema in bilateral lung fields. Comprehensive examination had no evident organic airway obstruction, and echocardiography showed normal cardiac function. This patient had been diagnosed with severe SAS with the apnea hypopnea index of 32 times/h. Therefore, we thought that the NPPE could be caused by severe SAS in this case. Continuous positive airway pressure therapy could improve this patient's symptoms promptly, and this patient could discharge without a complication. We should consider SAS as a cause of NPPE when examining NPPE patients especially with onset during sleep.

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“…In general, NPPE often demonstrates marked bilateral perihilar alveolar infiltrates on chest X-ray. Treatment modality includes supportive care such as careful post-op monitoring, reliving airway obstruction, oxygen supplementation, Bilevel Positive Airway Pressure (BIPAP) and assisted ventilation [61,62].…”

Section: Perioperative Negative Pressure Pulmonary Edema Versus Pulmomentioning

confidence: 99%

Airway Management in Full Stomach Conditions

Bassam¹,

Zaghw²,

Khan³

et al. 2021

Special Considerations in Human Airway Management

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Pulmonary aspiration in the perioperative period is one of the well-known complications under anesthesia and procedural sedation. A full stomach condition either due to non-adherence to fasting guidelines or due to various other factors that delay gastric emptying are the most common causes. Following aspiration, a patient may develop a wide spectrum of clinical sequelae. The key factors in preventing aspiration include proper pre-operative assessment, appropriate premedication and operating room preparations. Rapid sequence induction and intubation is the recommended technique for securing the airway in cases of full stomach. Management of aspiration depends on the nature of the aspirate. Pre-operative fasting guidelines have been established by various medical societies which may be modified in special circumstances of high risk of aspiration. Prediction of difficult airway in certain cases of full stomach necessitates clinical expertise in airway management.

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Negative pressure pulmonary edema after general anesthesia

Cited by 34 publications

References 26 publications

Postoperative pulmonary edema following vitrectomy in patients with ischemic heart disease and diastolic dysfunction in the post-anesthetic care unit

Postoperative pulmonary edema following vitrectomy in patients with ischemic heart disease and diastolic dysfunction in the post-anesthetic care unit

Negative pressure pulmonary edema related with severe sleep apnea syndrome: A case report

Airway Management in Full Stomach Conditions

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