PULMONARY-EDEMA FOLLOWING POSTOPERATIVE LARYNGOSPASM - A CASE-REPORT AND REVIEW OF THE LITERATURE

The pathophysiology of acute, negative-pressure pulmonary edema follow ing post-anesthetic laryngospasm (PLPE) is unclear. We present a patie nt and review the literature to propose etiology and management. Ninet een reported patients (3 female, 16 male, aged 3 months to 60 years) w ith PLPE had undergone 10 otolaryngologic, three orthopedic, four skin /soft tissue, one intraabdominal, and one ophthalmologic procedures. T welve patients (63%) had significant medical history. Initial intubati on was performed without difficulty in 17 patients, there were no pred isposing trends in anesthetic management, and post-anesthetic extubati on was performed without difficulty in 18 patients. Thirteen patients developed laryngospasm in less than 2 minutes. Eight were ventilated w ith bag/mask, 15 required reintubation, and nine required paralysis. O nset of PLPE was less than 3 minutes in 12 patients; chest roentgenogr ams showed edema in 17 patients. Mechanical ventilation was required f or less than 24 hours in all patients. PLPE cleared in less than 24 ho urs in most patients. Furosemide was administered in nine patients, di goxin in one, theophylline in two, and steroids in four patients. The precise pathophysiologic mechanism of PLPE is unclear despite numerous proposed mechanisms. PLPE resolves rapidly with short-term ventilator y support. Use of diuretics/airway dilators is variable, and their con tribution to management is unclear.