Pathak Vikas, Rendon Iliana S Hurtado, Ciubotaru Ronald L
Department of General Internal Medicine, Marshfield Clinic, WI 54449, USA.
Clin Med Res. 2011 Jun;9(2):88-91. doi: 10.3121/cmr.2010.936. Epub 2010 Sep 17.
An African-American man, aged 34 years, underwent an elective uncomplicated right wrist laceration repair while under general anesthesia. Following extubation, the patient developed hypoxemia, tachypnea, shortness of breath, pulmonary rales, frothy sputum, decreased oxygen saturation, and evidence of upper airway obstruction. Chest radiograph showed pulmonary edema. The patient was diagnosed with post-extubation pulmonary edema (aka. negative pressure pulmonary edema [NPPE]) and was treated with intravenous furosemide and oxygen therapy; he improved remarkably within a few hours. Once stabilized, the patient described a similar episode 10 years earlier following surgery for multiple gunshot wounds. Negative pressure pulmonary edema following tracheal extubation is an uncommon (0.1%) and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. Prevention and early relief of upper airway obstruction should decrease incidence. Recurrent NPPE has not been previously described in the literature. Herein, we describe the first case of recurrent NPPE in the same patient following extubation.
一名34岁的非裔美国男性在全身麻醉下接受了择期的、无并发症的右手腕裂伤修复手术。拔管后,患者出现低氧血症、呼吸急促、呼吸短促、肺部啰音、泡沫痰、氧饱和度下降以及上呼吸道梗阻的迹象。胸部X光片显示肺水肿。该患者被诊断为拔管后肺水肿(又称负压性肺水肿[NPPE]),并接受了静脉注射速尿和氧疗;他在数小时内显著好转。病情稳定后,患者描述10年前在接受多处枪伤手术时曾发生过类似情况。气管拔管后发生的负压性肺水肿是接受手术的气管插管和全身麻醉患者中一种罕见的(0.1%)且危及生命的并发症。这些病例的常见模式是在全身麻醉苏醒时发生气道梗阻事件,通常由喉痉挛引起。易发生气道梗阻的患者在全身麻醉拔管后发生气道并发症的风险可能会增加。预防和早期解除上呼吸道梗阻应可降低发病率。复发性NPPE此前在文献中尚未有描述。在此,我们描述了同一患者拔管后复发性NPPE的首例病例。