ACE Inhibitor-Induced Angioedema following Cervical Spine Surgery

Hannoodi, Faris; Sabbagh, Hussam

doi:10.1155/2017/4268962

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…The available literature contains many case reports of angioedema in surgical patients, suggesting direct injury caused by perioperative trauma (eg, intubation, lumbosacral spine surgery, c-spine surgery, shoulder surgery) as a trigger for angioedema in patients taking ACEIs or angiotensin II receptor blockers [ 3 , 7 , 14 , 15 ]. However, our search in PubMed (March 10, 2023) yielded only 1 case of local trauma-related angioedema outside the perioperative period, in a patient who bit her upper lip [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…While angioedema as a potentially life-threatening adverse reaction of angiotensin-converting enzyme inhibitors (ACEIs) is well-recognized, angioedema as an adverse reaction of angiotensin receptor blockers (ARBs) is relatively less studied and less reported [ 1 , 6 ]. Indeed, many cases of spontaneous angioedema and perioperative angioedema in patients taking ACEIs have been reported [ 7 ]. However, angioedema following local trauma in patients taking ARBs is rare in the literature, and our literature review in PubMed revealed only 1 similar case [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Trauma-Related Angioedema of the Airway in a Patient on an Angiotensin Receptor Blocker

Allihien,

Ibrahim,

Chaparala

et al. 2024

Am J Case Rep

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Patient: Female, 83-year-old Final Diagnosis: Angioedema Symptoms: Dyspena Clinical Procedure: — Specialty: Allergology • Cardiology • Immunology • Pharmacology and Pharmacy Objective: Unusual clinical course Background: Angioedema is non-pitting edema that occurs in the deep layers of the skin and subcutaneous tissue due to vascular leakage of plasma resulting from 1 of 2 major pathophysiological processes: mast cell-mediated angioedema and bradykinin-mediated angioedema. While it is a well-recognized adverse reaction of angiotensin-converting enzyme inhibitors, the association of angioedema with angiotensin receptor blockers is relatively less studied. Direct local trauma, although rarely, has been suggested to induce angioedema under certain conditions. We present a unique case of direct, local, trauma-related angioedema in a patient on an angiotensin receptor blocker. Case Report: The patient, an 83-year-old woman on telmisartan for hypertension, hit her neck against the edge of a chair during a fall. Shortly thereafter, she developed progressive airway compromise due to airway angioedema, as noted on direct laryngoscopy. A contrast CT scan of the neck also noted edema of the periglottic and supraglottic regions. She required intravenous corticosteroid administration and intubation in the emergency room and was successfully extubated 3 days after admission. She had no prior history of angioedema or allergy. We hypothesize that increased levels of circulatory bradykinin in the setting of telmisartan, combined with a local release of bradykinin from trauma, was the main pathophysiologic cause of the angioedema. Conclusions: This case report highlights the rare and often forgotten adverse reaction of angioedema with use of angiotensin receptor blockers and confirms the finding of local trauma as a possible trigger.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case of Trauma-Related Angioedema of the Airway in a Patient on an Angiotensin Receptor Blocker

Allihien,

Ibrahim,

Chaparala

et al. 2024

Am J Case Rep

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“…Angioedema is one of the earliest causes of postoperative airway compromise after ACSS and typically presents within 6–12 h. However, due to its rarity, it is often misdiagnosed [ Table 2 ]. [ 4 , 8 ] Further, angioedema is one of the known side effects of both risedronate and parecoxib, and has also been associated with a history of smoking; notably, our patient was a smoker [ Table 2 ]. [ 1 - 4 , 8 ] It is well known that corticosteroids reduce the risk of reintubation following ACSS.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 , 8 ] Further, angioedema is one of the known side effects of both risedronate and parecoxib, and has also been associated with a history of smoking; notably, our patient was a smoker [ Table 2 ]. [ 1 - 4 , 8 ] It is well known that corticosteroids reduce the risk of reintubation following ACSS. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Neck angioedema after anterior cervical discectomy and fusion with coexistent epiglottic cyst

Georgiopoulos

Papadakos

Kraniotis

et al. 2020

Surgical Neurology International

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Background: We present a case and reviewed the literature regarding airway obstruction and angioedema after an anterior cervical discectomy and fusion (ACDF). Case Description: A 60-year-old female with degenerative cervical myelopathy and a previously undiagnosed epiglottic cyst underwent a C5–C6 ACDF; notably, the anesthesiologist found an epiglottic cyst when the patient was first intubated. Two hours postoperatively, the patient acutely developed severe neck swelling with airway obstruction due to angioedema. She was immediately treated with hydrocortisone and required a tracheostomy. The edema decreased markedly in the next 12 h and by the 3rd postoperative day it resolved. Three months later, she had no residual medical sequelae. Conclusion: Patients with epiglottic cysts who need cervical spine surgery should either first have the cyst treated or should be closely monitored postoperatively.

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“…Few cases of angioedema following anesthesia in patients using ACE inhibitors have been reported. [ 4 – 7 ]. However to the best of our knowledge, none has reported intraoperative angiotensin II receptor blocker-induced angioedema.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative angioedema induced by angiotensin II receptor blocker: a case report

et al. 2018

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BackgroundAngiotensin II receptor blockers are a class of antihypertensive agent that is developed to exclude the adverse effects of angiotensin converting enzyme inhibitors. However, as angiotensin II receptor blockers have begun to be more widely prescribed, cases of angiotensin II receptor blocker-induced angioedema have been reported. Rare cases of angioedema following surgery in patients using angiotensin converting enzyme inhibitors have been published.Case presentationA 38-year-old man with past history of hypertension was admitted for an elective lumbosacral spine surgery. He had been taking Valsartan 160 mg a day for the past 4 years.At the end of the surgical procedure and turning the patient into supine position, we noticed severe swelling in the neck and the face with.an edematous tongue, floor of the mouth, glottis, and supraglottic areas. A diagnosis of drug induced angioedema was made and intravenous dexamethasone, diphenhydramine and ranitidine were given. The patient remained intubated and was transferred to the intensive care unit. The valsartan was suspected to be the precipitating factor for the angioedema and was therefore discontinued.The swelling started to regress after 2 h, and resolved completely by the third day.ConclusionThe precise mechanism of angiotensin II receptor blocker-induced angioedema is still unknown and should be thoroughly investigated. This report demonstrates a unique case of intraoperative angiotensin II receptor blocker-induced angioedema. Potential differential diagnoses of postoperative facial edema are discussed in detail, including the prolonged prone positioning for posterior spine surgery. Anesthesiologists should be aware of such rare, but potentially dangerous, perioperative adverse reaction that can occur with angiotensin II receptor blockers use.

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ACE Inhibitor-Induced Angioedema following Cervical Spine Surgery

Cited by 4 publications

References 10 publications

A Case of Trauma-Related Angioedema of the Airway in a Patient on an Angiotensin Receptor Blocker

A Case of Trauma-Related Angioedema of the Airway in a Patient on an Angiotensin Receptor Blocker

Neck angioedema after anterior cervical discectomy and fusion with coexistent epiglottic cyst

Intraoperative angioedema induced by angiotensin II receptor blocker: a case report

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