Post-obstruction pulmonary edema complicated by transient cardiac dysfunction in a young woman


A 17-year-old woman who had been healthy since birth developed postobstruction pulmonary edema (POPE) after maxillofacial surgery. She was extubated in a semi-conscious state after general anesthesia, and developed severe airway obstruction due to glossoptosis, and blood and secretions in the oral cavity. When the obstruction was released approximately 10 min later, the chest radiograph showed an increased cardiothoracic ratio, and cardiac ultrasonography showed a reduction in the left ventricular ejection fraction when compared to the normal values for the same age. A diagnosis of type-I POPE with associated left ventricular dysfunction was made, and oxygen and diuretic administration were initiated. When continued hypoxemia is found, even after the elimination of any airway obstruction, it is important to evaluate left cardiac function, with due consideration to the possibility of POPE.

Post-obstruction pulmonary edema (POPE) has been defined as non-cardiogenic pulmonary edema that follows upper airway obstruction. It is classified as either type-I POPE, which is primarily negative-pressure pulmonary edema, or type-II POPE, in which venous perfusion is increased by the elimination of expiratory disorders, leading to an increase in hydrostatic pressure in the pulmonary capillaries.

In patients developing acute upper airway obstruction, the incidence of POPE has been estimated to be up to 12 %. Laryngospasm during intubation or after anesthesia is reported to be the most common cause of upper airway obstruction leading to POPE in adults, and it has been reported to account for as much as 50% of the cases. This report presents the case of a young woman who had been healthy since birth. She underwent maxillofacial surgery under general anesthesia with endotracheal intubation, and at the time of extubation developed a type-I POPE associated reduction of cardiac function.

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