Author Affiliations: Departments of Otolarynogology (Drs Westreich and Lawson) and Anesthesiology (Dr Sampson), Mount Sinai Hospital, New York, NY; and Division of Head and Neck Cancer, The Cancer Center at Hackensack University Medical Center, Hackensack, NJ (Dr Shaari).
Correspondence: Richard Westreich, MD, Mount Sinai Hospital, Department of Otolaryngology, 1 Gustave L. Levy Pl, Box 1189, New York, NY 10029 (firstname.lastname@example.org).
Objective To provide rhinologic surgeons with an understanding of acute negative-pressure pulmonary edema (NPPE) and its treatment.
Design Case report and literature review of all published adult cases of NPPE. Patient factors, anesthetic variables, and outcomes are assessed.
Results A total of 146 cases in 45 case reports and series were compiled. There was approximately a 2:1 male-female patient ratio. The average age of the patients was 33 years. Fifty percent of patients had surgery on the upper aerodigestive tract, and 8% had intranasal surgery. No patients received laryngotracheal anesthesia, and 5 of the 146 received intravenous lidocaine prior to extubation. One patient had NPPE following laryngeal mask airway treatment, and 2 patients experienced this complication after conversion from monitored anesthesia care to general endotracheal anesthesia; 33.5% of patients were treated with continuous positive airway pressure alone, while 66.5% required intubation and mechanical ventilation. The average time to resolution was 11.75 hours. Three patients died.
Conclusions It is known that surgical procedures involving the upper aerodigestive tract have a higher risk of NPPE than other procedures. Rapid diagnosis and treatment is necessary to achieve early resolution and avoid significant patient morbidity. A thorough understanding is integral to the practice of nasal and paranasal sinus surgery, especially with the rising use of outpatient and office-based surgical suites. Therefore, we present a review of pathophysiologic mechanisms, possible risk factors, treatment options, and potential steps that can be taken to minimize this potentially devastating complication of general anesthesia.
Westreich R, Sampson I, Shaari CM, Lawson W. Negative-Pressure Pulmonary Edema After Routine SeptorhinoplastyDiscussion of Pathophysiology, Treatment, and Prevention. Arch Facial Plast Surg. 2006;8(1):8-15. doi:10.1001/archfaci.8.1.8