Acute pulmonary edema secondary to acute upper airway obstruction]

We report a 72 years old woman with mild arterial hypertension and no other pathological history who presented an acute pulmonary edema due to acute obstruction of the upper airway secondary to vocal chord paralysis developing during the immediate postoperative phase of thyroidectomy. The acute pulmonary edema resolved after application of tracheal reintubation, mechanical ventilation controlled with end expiratory positive pressure, diuretics, morphine, and liquid restriction. We discuss the possible etiopathogenic possibilities of this infrequent clinical picture and we suggest that all patients who suffered and acute obstruction of the upper airways require a careful clinical surveillance in order to prevent the development of the pulmonary syndrome.     

Perioperative acute upper airway obstruction secondary to severe rheumatoid arthritis

Although airway obstruction secondary to cricoarytenoid arthritis is an infrequent perioperative complication of rheumatoid arthritis, it must be promptly recognized and appropriately managed to avoid fatal consequences. We report a case of cricoarytenoid dysfunction leading to acute respiratory insufficiency requiring tracheostomy in the immediate postoperative period after total knee arthroplasty in a patient with severe rheumatoid arthritis.     

Life-threatening upper airway obstruction in a child caused by retropharyngeal emphysema

A 2 1/2-year-old boy with acute obstructive lung disease from adenovirus infection developed cough-induced paroxysms of intense dyspnoea leading to respiratory failure. Chest x-ray and fluoroscopy demonstrated retropharyngeal air occluding the airway. The clinical management of this and similar air-leak problems is discussed.     

Pulmonary edema due to upper airway obstruction after extubation

We report a patient who developed pulmonary edema due to airway obstruction after extubation. A 22-year-old man underwent removal of the nails for thoracoplasty under general anesthesia combined with epidural anesthesia. Upper airway obstruction occurred after extubation. SpO2 decreased to 70%. Insertion of an oral airway relieved the airway obstruction. However, inspiratory wheezing was heard over both lung fields. Chest X-ray taken 90 minutes after the event revealed pulmonary edema. Pulmonary edema gradually resolved after intravenous furosemide and oxygen inhalation by mask.     

Post-traumatic upper airway obstruction secondary to a lingual artery hematoma

An accident victim presented with maxillofacial trauma complicating a head injury. After the airway was secured by tracheostomy, surgical exploration revealed a lingual artery hematoma. This case illustrates the progressive airway occlusion seen with this disorder and the importance of repeated oral examinations.     

Evaluation and management of acute upper airway obstruction

Upper airway obstruction can occur suddenly and result in a patient's rapid deterioration. In this article we provide a structured approach to identifying those patients with acute airway compromise and stratifying them according to clinical urgency. This includes ways of distinguishing both the level of obstruction and its severity, based on the clinical signs and symptoms, and the role and timing of investigations. We describe the key aspects of emergency management, including temporizing measures and airway adjuncts. Management of rare, but important, situations are discussed such as post-thyroidectomy haematoma, occlusion of tracheostomy and laryngectomy stomas and post-obstruction pulmonary oedema (POPE) is discussed. We describe the situation when an emergency surgical airway should be considered, along with our technique of performing one.     

Evaluation and management of acute upper airway obstruction

Upper airway obstruction can occur suddenly and result in a patient’s rapid deterioration. In this article we provide a structured approach to identifying those patients with acute airway compromise and stratifying them according to clinical urgency. This includes ways of distinguishing both the level of obstruction and its severity, based on the clinical signs and symptoms, and the role and timing of investigations. We describe the key aspects of emergency management, including temporizing measures and airway adjuncts. Management of rare, but important, situations are discussed such as post-thyroidectomy haematoma, occlusion of tracheostomy and laryngectomy stomas and post-obstruction pulmonary oedema (POPE) is discussed. We describe the situation when an emergency surgical airway should be considered, along with our technique of performing one.     

Pulmonary edema following acute upper airway obstruction

During recovery, our patient presented an acute upper airway occlusion. After the removal of the airway obstruction, he developed a massive bilateral pulmonary edema with an acute hypoxemia. Hemodynamic measures following this incident show that mean and wedged pulmonary pressures are in the normal ranges. Several cases, associating acute upper airway obstruction, massive bilateral pulmonary edema and low or normal filling pressures, have been reported in literature. Three mechanisms have been postulated to explain this phenomenon; a dramatic increase of the negativity of the interstitial pulmonary pressure, a significative augmentation of the after-load and the hypoxic pulmonary reflex vasoconstriction.     

Acute upper airway angioedema secondary to acquired C1 esterase inhibitor deficiency: a case report

PURPOSE: Adverse reactions to local anesthetics are widely reported. We report a case of acute upper airway angioedema presumed to be due to the local anesthetic articaine, which was subsequently diagnosed as acquired C1 esterase inhibitor deficiency. CLINICAL FEATURES: A 54-yr-old woman presented with a history of progressive facial and periorbital edema 24 hr after receiving articaine local anesthetic for a dental procedure. She was in mild respiratory distress but was not stridorous. After inhalational induction with sevoflurane in the operating room, direct laryngoscopy revealed marked edema of supraglottic structures including epiglottis, uvula and aryepiglottic folds and the larynx was not visualized. The patient's trachea was intubated under direct laryngoscopy. Seventy-two hours later, the endotracheal tube was removed and she made an uneventful recovery. Initially, the angioedema was thought to be caused by a hypersensitivity reaction to articaine. Later investigations showed normal C3 complement level, very low C4 complement and C1 esterase inhibitor levels confirming a diagnosis of C1 esterase inhibitor deficiency. Subsequently, the patient was started on androgen therapy. Her C1 esterase inhibitor level normalized and she remained symptom free nine months after initial presentation. CONCLUSION: We report a case of acute upper airway angioedema secondary to C1 esterase inhibitor deficiency requiring emergency airway management. Anesthesiologists should consider C1 esterase inhibitor deficiency in the differential diagnosis of patients with airway edema and be familiar with the acute and prophylactic treatment of patients with this diagnosis.     

Emergency adenotonsillectomy for acute postoperative upper airway obstruction

Peri-operative acute upper airway obstruction may be life-threatening. A case is reported of a child with severe adenotonsillar hypertrophy who developed acute upper airway obstruction after a routine surgical procedure and required emergency adenotonsillectomy. The importance of pre-operative assessment is stressed.