NEGATIVE-PRESSURE PULMONARY-EDEMA INDUCED BY DIRECT SUCTIONING OF ENDOTRACHEAL TRIBE ADAPTER

Purpose: Negative pressure pulmonary oedema (NPPE) is a well-recognize d but rare complication secondary to upper airway obstruction such as laryngeal spasm during emergence from general anaesthesia, Cauterizati on of the second and third thoracic sympathetic ganglia is a treatment for hyperhidrosis of the hands, We report a case of NPPE induced by d irect suctioning of the endotracheal tube adapter during thoracic symp athetic ganglionectomy without recognized upper airway obstruction. Cl inical features: A 19-yr-old otherwise healthy non-smoking man was sch eduled for elective bilateral chest endoscopic ablation of the second and third thoracic sympathetic ganglion for hyperhidrosis of the hands under general anaesthesia. To view and cauterize the ganglion with th e endoscope, the surgeon requested cessation of positive pressure vent ilation. As the surgeon could not satisfactorily visualize the target ganglia, he;requested brief application of wall suction via the ETT tu be adapter. A pressure of -100 mmHg was generated which lasted for thr ee to four seconds. The goal was to reduce further the lung volume by increasing the pneumothorax produced by the endoscope, The patient dev eloped negative pressure pulmonary oedema without upper airway obstruc tion. Conclusion: This case demonstrated that intrathoracic negative p ressure generated by direct ETT adapter suctioning may produce pulmona ry oedema similar to that induced by laryngeal spasm during the emerge nce of general anaesthesia.