Acute Noncardiogenic Pulmonary Edema Following Neostigmine Administration in the Endotracheal Intubation State After Tonsillectomy

Abstract

Acute pulmonary edema during the perioperative period can have various causes. A 20-year-old woman was admitted for tonsillectomy and adenoidectomy. She had nasal congestion for 2 months, chronic sinusitis with polyps, and diffuse lymphoid hyperplasia. A biopsy and peripheral blood smear were performed to rule out a lymphoma before surgery. We injected neostigmine 1.5 mg and glycopyrrolate 0.4 mg at the end of the surgery. Two minutes later, the secretion and peak airway pressure increased as well as the CO2 levels. The patient remained sedated and suctioning continued for approximately 20 min before extubation. The secretions reduced and there was an improvement in clinical symptoms as the pinkish foamy pattern became whitish. Presumed treatment of neostigmine hypersensitivity or surgery can be used to resolve perioperative chronic partial airway obstruction.