Non-cardiogenic pulmonary oedema after neostigmine given for reversal: A report of two cases

Raiger, Lalit Kumar; Naithani, Udita; Vijay, Bhavani S; Gupta, Pradeep; Bhargava, Vaibhav

doi:10.4103/0019-5049.68386

Cited by 10 publications

(11 citation statements)

References 6 publications

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“…IVIG can cause hyperviscosity and is hypothesized to cause coronary vasospasm due to release of cytokines and can cause elevations in catecholamines [10]. Neostigmine in another report was described to precipitate noncardiogenic pulmonary edema neostigmine in our patient was continued even after pulmonary edema without further worsening [11]. Another feature of our patient was the coexistence of SLE autoantibodies and proteinuria with MG.…”

Section: Discussionmentioning

confidence: 80%

Pulmonary Edema in Myasthenic Crisis

Anand

Viswanathan

Arulneyam

2013

Case Reports in Critical Care

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We report a previously asymptomatic 50-year-old lady who came with myasthenic crisis as initial presentation of myasthenia gravis. She developed pulmonary edema following intravenous immunoglobulin administration and had ischemic changes in ECG and left ventricular dysfunction on echocardiography. She improved with diuretics, dobutamine, and fluid restriction alone. This is the first report in English-language medical literature describing the association between myasthenic crisis and likely takotsubo cardiomyopathy-related pulmonary edema following intravenous immunoglobulin administration.

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Section: Discussionmentioning

confidence: 80%

Pulmonary Edema in Myasthenic Crisis

Anand

Viswanathan

Arulneyam

2013

Case Reports in Critical Care

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“…Raiger et al 1 have reported two cases of NCPE following use of neostigmine for neuromuscular blockade reversal. Both patients had no previous cardiovascular illness and underwent non-laparoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

“…There are no major adverse drug reactions in most patients. However, a literature survey reveals the occurrence of non-cardiogenic pulmonary oedema (NCPE) following the use of neostigmine to antagonise the neuromuscular blockade as a rare and idiosyncratic complication 1. Anaphylaxis and cardiovascular collapse have also been reported in another case 2.…”

Section: Introductionmentioning

confidence: 99%

Neostigmine and pulmonary oedema

et al. 2014

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SUMMARYA 1-year-old child with no pre-existing cardiac or respiratory disease developed frank pulmonary oedema after administration of a neostigmine-glycopyrrolate mixture to reverse neuromuscular blockade during general anaesthesia. Possible cardiac and extra-cardiac factors that could cause pulmonary oedema in this child were ruled out by appropriate investigations. As the pulmonary oedema manifested shortly after administration of the neostigmine-glycopyrrolate mixture, we concluded that neostigmine was the most probable cause. This article briefly reports the occurrence of events and successful management of perioperative pulmonary oedema. BACKGROUND

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“…NPPE majority before surgery was determined by anaesthetists as laryngospasm issue [1][2][3][4]. Young athlete males who undergo head and neck surgeries or painful procedures are more prepared for NPPE than normal patients, because their muscular chest walls could create very high inspiratory pressures [5][6][7]. NPPE incidence is reported to range from 0.05 to 1%, which is related to all anaesthesia usages [8].…”

Section: Discussionmentioning

confidence: 99%

Negative Pressure Pulmonary Oedema: A Rare Case Report of Two Brothers

Jaafarpour

Khajavikhan²,

Khani³

2013

JCDR

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A 19-year-old-man, an Iranian, a professional athlete, (weight, 65 kg; height, 170cm), a candidate for varicocele surgery under general anaesthesia. He was without any history of previous anaesthetic exposure, illness, use of drug and history of allergy. Chest X-ray, ECG, laboratory tests and physical examination were within normal limits. The patient was accepted for anaesthesia, as he had ASA I physical status.In the operation room, after placing standard monitors, the patient was premedicated with injection fentanyl 100 μgm intravenous and general anaesthesia was induced with Thiopental Sodium 5 mg/ kg, Atracurium 0.5 mg/ kg . He was intubated without problems using a 7.5 mm oral endotracheal tube that was fixed 22 cm from the mouth. Over the operative period (1 h), 1000 mL of lactated Ringer's solution was given. Anaesthesia was maintained by Halotan 0.8%, N 2o: O 2 (50 : 50) and Atracurium. The tracheal intubation, anaesthesia, mechanical ventilation, and surgical procedure were uneventful. At the end, oropharyngeal suctioning was done and reversed using injection Neostigmine 2.5 mg IV, and injection Atropine Sulfate 1.0mg IV and subsequently, the trachea was extubated. Directly after extubation, the patient developed laryngospasm and became agitated. Respiratory distress, tachypnoea and cyanosis were observed. Spontaneous ventilation with 100% oxygen could not be assisted by bag and mask ventilation sufficiently and he developed laryngospasm with severe respiratory distress. Subsequently, arterial oxygen saturation decreased to a low 70. The patient was reintubated after administration of Succinylcholine (1mg.kg) and Dexamethasone 8mg. Suctioning of the tube revealed copious amounts of pink, frothy sputum. Chest radiograph showed a small right lower lobe infiltrate. In operation room, he was placed on mechanical ventilation and treated with positive end-expiratory pressure (PEEP) of 10 cm H 2 O, high fractional inspiratory oxygen concentration (FIO 2 ), intravenous furosemide and morphin initially. Arterial blood gas levels were within normal limits. His extubation was successfully carried out 4 hours after his initial reintubation. He had an uneventful recovery and was transferred to the surgical ward.In surgical ward, remarkable note was derangement in coagulation profile, prothrombin time (PT) and partial thromboplastin time (PTT) (PT=24sec, PTT=54sec). The patient recovered completely and was discharged home on the postoperative day. Case TWOOur second case, brother of the case one, underwent general anaesthesia for septoplasty 3 years later in our hospital. A 17 yearold-man, an Iranian,and a professional athlete, (weight, 82 kg; height, 187 cm). He was also without history of previous anaesthetic exposure, illness, drug use and history of allergy. Chest X-ray ,ECG, laboratory tests and physical examination were within normal limits. The patient was accepted for anaesthesia, as he had ASA I physical status. In the operation room, after placing standard monitors, the patient was premedicated with inject...

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Non-cardiogenic pulmonary oedema after neostigmine given for reversal: A report of two cases

Cited by 10 publications

References 6 publications

Pulmonary Edema in Myasthenic Crisis

Pulmonary Edema in Myasthenic Crisis

Neostigmine and pulmonary oedema

Negative Pressure Pulmonary Oedema: A Rare Case Report of Two Brothers

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