Negative Pressure Pulmonary Edema After Septorhinoplasty Surgery: A Rare Complication
Elmas Yılmaz Kara, Günhan Gökahmetoğlu, Urfettin Hüseyinoğlu, Murat İzgi, Emin Silay,
Hacettepe University School Of Medicine, Anesthesiology And Reanimation Department, AnkaraKayseri City Hospital, Anesthesiology And Reanimation Clinique, Kayseri
Background: Negative pressure pulmonary edema (NPPE) is defined as fluid transudation into the pulmonary interstitium which occurs as a result of elevated negative intrathoracic pressure caused by the upper respiratory tract obstruction and strong inspiratory effort. We experienced a case of NPPE after tracheal extubation following septorhinoplasty surgery. Case Report: A 24-year-old-woman underwent septorhinoplasty operation and developed NPPE. She was in ASA grade I and her blood investigations and chest-x-ray were normal. General-anesthesia was induced by intravenous administration of propofol 120mg and fentanil 50mcg and was maintained by sevoflurane 1.5-2% and infusion of remifentanil 0.1-0.2mcg/kg/min. Rocuronium-30mg was used to facilitate tracheal intubation. The surgery was finished uneventfully. The effect of the relaxant was reversed using neostigmine 1.5mg and atropine 0.5mg administered intravenously. The patient was then extubated, which was uneventful, and an adequate recovery was achieved. After transfering to the postoperative ward, she developed a brief episode of laryngospasm and respiratory distress in the form of paradoxical chest movements and was markedly agitated. She had hypotension and tachycardia but SPO2 did not drop below 80%. Bilateral auscultation revealed abnormal breath sounds and frothy pink sputum was noted to be coming from the patient's mouth. Chest-X-ray obtained revealed marked bilateral pulmonary edema. The patient was admitted to the ICU and received continuous positive airway pressure ventilation and administration of furosemide for 36 hour after the surgery. The patient's clinical findings were normal and control chest radiography was close to normal. The patient discharged to Plastic-Surgery service and then to home from here without any problems. Discussion: NPPE is an uncommon and life-threating complication of general anesthesia caused by laryngospasm. Its recognition helps to minimise morbidity and mortality. This case report highlights the importance of early diagnosis and prompt management of-NPPE to save the life of the patient.
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