Negative pressure pulmonary edema after general anesthesia: A case report and literature review

Abstract

Rationale: Negative pressure pulmonary edema (NPPE) is a dangerous clinical complication and potentially life-threatening emergency without prompt diagnosis and intervention during recovery period after anesthetic extubation. Patient concerns: A 25-year-old woman has undergone endoscopic thyroidectomy. After extubation, the patient developed acute respiratory distress with high airway resistance accompanied with wheezing, oxyhemoglobin saturation (SpO2) decreased to 70%. With positive pressure mask ventilation, her condition was stable, SpO2 99%. However, the patient developed pink frothy sputum with diffuse bilateral rales 30min later after transported to surgical intensive care unit (SICU). Diagnoses: Negative pressure pulmonary edema. Interventions: The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and furosemide 20mg was given intravenously. Outcomes: Postoperative day (POD) 2 her condition became stable, computed tomography (CT) scan indicated the pulmonary edema disappeared. The patient was discharged 6days later. No abnormalities were observed during following 4weeks. Lessons: Although usually the onset of NPPE is rapid, with individual differences NPPE is still challenging. Increased vigilance in monitoring, diagnosis, and treatment are essential to prevent aggravation and further complication.