Negative Pressure Pulmonary Edema After Oral and Maxillofacial Surgery

Abstract

Negative pressure pulmonary edema ( NPPE ) following upper airway obstruction (UAO) has been reported in several clinical situations. The main cause of NPPE is reported to be increased negative intrathoracic pressure. We present a case of NPPE that occurred after general anesthesia for plate removal after jaw deformity surgery. After completion of the surgery, administration of inhaled anesthetics was stopped and the patient opened his eyes on verbal command. Immediately after extubation, the patient stopped breathing and became cyanotic. Acute UAO following laryngospasm was suspected. Soon after reintubation, pink, frothy fluid came out of the endotracheal tube, and a tentative diagnosis of NPPE was made. Continuous positive airway pressure was applied. In addition, furosemide and dexamethasone were administered. By the next day, the symptoms had almost disappeared.

Negative pressure pulmonary edema after general anesthesia

“…Other procedure that increases the risk of NPPE includes oropharyngeal, head, and neck surgery. Five [8–12] of the reported 29 cases involved upper respiratory tract surgery, and 10 [1,3,6,7,13–18] of the cases involved head and neck surgery, which may be related to tissue swelling and the sensitive dilator muscle of the upper airway in head and neck surgeries. Although our patient underwent endoscopic thyroidectomy with no wound in the neck skin, it was inevitable for neck tissue and muscle injury.…”

“…This occurs in 0.05% to 0.1% of cases as a serious complication of general anesthesia with tracheal intubation, [1,2] and more than half of these cases are related to postanesthetic laryngospasm. [3,4] Postanesthetic NPPE is a potentially life-threatening emergency and occurs more frequently than reported in studies, which should cause the attention for anesthesiologists. Here, we presented a rare case of “delayed” NPPE in a young woman after endoscopic thyroidectomy and reviewed the reported cases of NPPE over the past decade.…”

Negative Pressure Pulmonary Oedema After Septoplasty

“…It should be emphasised that it is important to keep this condition in mind following any type of surgical intervention in healthy, young patients who present hypoxaemia not explained by other causes and establish the therapeutic measures needed to avoid an unfavourable patient evolution. 14 In this specific case, we believe that the evolution, although brief, would have been better if CPAP had been added to the treatment in the PARU.…”

“…12,13 Clinical presentation is dyspnoea, expectoration, cyanosis, tachypnoea and tachycardia; the risk factors are obesity, sleep apnoeas, a short neck and excessive development of muscle mass. 14 A respiratory clinical exam during the immediate postoperative period will identify the presence of signs of lung oedema, as long as the presence of stridor, pulmonary crackling and respiratory insufficiency, assessed using pulse oxygen analysis, are taken into account. 4,10,12 Spontaneous resolution of the entity in mild cases and resolution with few therapeutic measures contribute to the under diagnosis of the problem.…”

Systematic Review of Negative Pressure Pulmonary Edema in Otolaryngology Procedures

“…A total of 69 studies, all of which were case series or case reports met final inclusion criteria (Supplemental Table 2). 2,3,9–73 Studies were dated between 1977 and 2016. In total, data from 87 individual patients was accessed across 69 studies.…”