Negative Pressure Pulmonary Edema Related to Laryngospasm and Upper Airway Obstruction in a Patient With Treacher Collins Syndrome

Abstract

Laryngospasm is an uncommon complication of anesthesia in adults but more common in pediatric anesthesia, which could present similarly to supraglottic upper airway obstruction. The management of such airway complications is even more difficult in patients with difficult mask ventilation and intubation. Our case illustrated the management of laryngospasm and negative pressure pulmonary edema in a patient with Treacher Collins syndrome. A literature search revealed few previous similar reports. We demonstrated an algorithm to differentiate between the true laryngospasm from the supraglottic upper airway obstruction, the management of laryngospasm in patients with difficult airways, and the recognition and management of negative pressure pulmonary edema as a complication of laryngospasm.

Negative pressure pulmonary edema (Review)

“…A dose of 1-2 mg/kg of lidocaine 5 min before tracheal extubation has been reported to reduce laryngospasm in children ( 67 , 68 ). Propofol at a dose of 0.5 mg/kg administered 60 sec before extubation was also effective in reducing the incidence of laryngospasm ( 66 , 69 ). In addition, the cuff leak test could help prevent the risk of post-extubation edema ( 62 ).…”

“…A dose of 5 mg of dexamethasone may be used before extubation to reduce laryngeal edema caused by multiple intubation attempts ( 64 , 65 ). This effect is associated with a reduction in the frequency of laryngospasms by deepening anesthesia and enhancing muscle relaxation ( 66 ). A dose of 1-2 mg/kg of lidocaine 5 min before tracheal extubation has been reported to reduce laryngospasm in children ( 67 , 68 ).…”