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November 11, 1968

Acute Laryngeal Obstruction After Endotracheal Anesthesia

Author Affiliations

From the Department of Anesthesia, University of California Medical Center, San Francisco. Dr. Stoelting is now with the Department of Anesthesia, National Institutes of Health, Bethesda, Md.; William K. Hamilton, MD, Department of Anesthesia, University of California Medical Center, San Francisco, is editor of the Anesthesia Problem of the Month series.

JAMA. 1968;206(7):1558-1559. doi:10.1001/jama.1968.03150070096019

Laryngeal edema as a complication of endotracheal anesthesia is a confusing subject. In the past, efforts were made to avoid tracheal intubation for fear of this complication. These fears were greater when children were involved. Even thoracic surgery was performed without endotracheal tubes, and it was over much surgical objection that "tubing a patient" became routine. Today, securing the airway with endotracheal tubes appears so successful that it is used to supplant or delay tracheotomy. Recently, complications of such long-term endotracheal intubation are being recognized. Postintubation laryngeal edema, however, is still a relatively rare complication of general endotracheal anesthesia. Recently, four cases of postintubation laryngeal edema occurred in our hospital during a ten-day period. All were in patients of pediatric age who were undergoing open-heart surgery. This near epidemic prompted us to search carefully for possible causes.

Report of Cases 

Case 1.—  This patient, a 4-year-old girl, weighed 15 kg