Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention

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.     

喉返神经损伤后环杓关节变化的观察

为观察喉返神经（ＲＬＮ）损伤后杓状软骨及环杓关节的变化，将１８只犬分为３组。第１单侧ＲＬＮ不完全损伤，第２组为单侧ＲＬＮ完全损伤，第３组为双侧ＲＬＮ损伤。结果第１组随着ＲＬＮ的自行修复，杓状软骨恢复正常无环杓关节纤维化；第２组随着时间的推移，出现杓状软固定，环杓关节纤维化亦加重；第３组较时时间就出现杓状软骨固定，且随时间推移，环杓关节纤维化程度亦较第２组严重     

水通道蛋白1、2、5在膜迷路积水豚鼠耳蜗中的分布及表达研究

目的观察水通道蛋白(aquaporin,AQ)1、2、5(AQP1、AQP2、AQP5)三种蛋白在膜迷路积水豚鼠耳蜗的表达及分布情况,探讨其在内淋巴积液中可能的发生机制。方法选择健康红目豚鼠60只,随机分为空白组(30只)和模型组(30只),模型组给予醋酸去氨加压素6μg·kg-1·d-1腹腔注射10 d,空白组以1 ml生理盐水腹腔注射10 d;常规饲养7天后取出耳蜗,通过免疫组化、Western-blot方法观察AQP1、AQP2、AQP5蛋白在豚鼠耳蜗的分布及表达。结果免疫组化示空白组、模型组豚鼠耳蜗组织中AQP1表达的光密度值分别为0.134±0.021、0.273±0.053;AQP2表达分别为0.089±0.013、0.261±0.100;AQP5表达分别为0.264±0.065、0.151±0.098;与空白组比较,模型组AQP1、AQP2蛋白表达明显上调(P<0.01),AQP5蛋白表达明显下调(P<0.05)。Western-blot示空白组、模型组豚鼠耳蜗组织中AQP1表达分别为0.214±0.034、0.313±0.032;AQP2表达分别为0.283±0.050、0.544±0.042;AQP5表达分别为0.291±0.041、0.199±0.033;与空白组比较,模型组AQP1、AQP2蛋白表达上调(P<0.01),AQP5蛋白表达明显下调(P<0.05)。结论AQP1、AQP2、AQP5蛋白均可能参与了豚鼠耳蜗膜迷路积水的发生。