Edema pulmonar por pressão negativa após hipofisectomia transesfenoidal: relato de caso

Abstract

BACKGROUND AND OBJECTIVES:Negative-pressure pulmonary edema (NPPE) is a rare complication that evolves rapidly after acute or chronic obstruction of the airways. The objective of this report was to present a case of NPPE after upper airways obstruction in a patient with acromegaly who underwent transsphenoidal hypophysectomy. CASE REPORT:A 48 years old male patient, weighing 80 kg, physical status ASA III, with a tumor in the hypophysis, hypertension, and acromegaly, underwent transsphenoidal hypophysectomy under general balanced anesthesia. The surgery proceeded without intercurrences. The patient was extubated while in a superficial anesthetic plane. He developed difficulty breathing, retraction of the abdominal wall, severe hypoxemia (SpO 2 30%), unconsciousness, and cardiac arrhythmia (PVCs and bradycardia). Positive-pressure ventilation with a face mask and oropharyngeal cannula was ineffective. The patient was intubated and, at this moment, there were bilateral pulmonary rales and frothy pinkish secretion inside the tracheal tube, compatible with NPPE. The patient was transferred to the ICU and remained on mechanical ventilation for 96 hours. He was discharged to the regular ward on the 5 th postoperative day without neurological sequelae. CONCLUSION:Negative-pressure pulmonary edema may occur in the immediate postoperative period of transsphenoidal hypophysectomy. Immediate diagnosis and treatment are essential for early resolution of the process and to decrease morbidity.

Negative pressure pulmonary edema after general anesthesia

“…Other procedure that increases the risk of NPPE includes oropharyngeal, head, and neck surgery. Five [8–12] of the reported 29 cases involved upper respiratory tract surgery, and 10 [1,3,6,7,13–18] of the cases involved head and neck surgery, which may be related to tissue swelling and the sensitive dilator muscle of the upper airway in head and neck surgeries. Although our patient underwent endoscopic thyroidectomy with no wound in the neck skin, it was inevitable for neck tissue and muscle injury.…”

“…NPPE was first reported in 1977. This occurs in 0.05% to 0.1% of cases as a serious complication of general anesthesia with tracheal intubation, [1,2] and more than half of these cases are related to postanesthetic laryngospasm. [3,4] Postanesthetic NPPE is a potentially life-threatening emergency and occurs more frequently than reported in studies, which should cause the attention for anesthesiologists.…”

Successful intraoperative management in patients with abdominal compartment syndrome induced by giant liposarcomas

“…Previous reports also stated that there was a risk of re-expansion pulmonary edema (RPE) after removal of the tumor. [16] RPE develops upon rapid expansion of chronically collapsed lungs through the mechanism of increased pulmonary vascular permeability and there is no standard method to prevent it. The first case presented with pulmonary atelectasis preoperatively, while the second case did not.…”

Acute respiratory distress syndrome and outcomes after near hanging

“…Cerebral hypoxia induced in animals has been shown to lead to pulmonary changes consistent with ARDS development[22–24]. During hanging attempts, acute negative intrathoracic pressure developing after upper airway obstruction may cause disruption of the alveolar-capillary membrane[25]; which is termed negative pressure pulmonary edema (NPPE)[7; 8; 26; 27] or post-obstructive pulmonary edema (POPE)[6; 28]. While the pathophysiology of NPPE involves hydrostatic pressure, this is not left atrial hydrostatic pressure, thus defining it as ARDS[25].…”