Negative pressure pulmonary edema causing postoperative hypoxemia: is there a relationship with the administration of sugammadex?

Abstract

Negative pressure pulmonary edema is an uncommon cause of postoperative hypoxemia. Following upper air- way obstruction, negative pressure pulmonary edema oc- curs due to the generation of negative intrathoracic pres- sure by forceful inhalation against an obstructed upper airway. This complication has previously been described in the context of laryngospasm during anesthetic care as well as a variety of other clinical scenarios including strangulation, foreign body aspiration, and obstructive sleep apnea. In the postoperative patient, management of this complication requires recognition and differentiation from other etiologies of hypoxemia. We present a 17- year-old adolescent who developed hypoxemia in the post-anesthesia care unit due to negative pressure pulmo- nary edema following laryngospasm during emergence from anesthesia and tracheal extubation. The differential diagnosis of postoperative hypoxemia in an otherwise healthy patient is presented, investigative work-up re- viewed, and treatment options discussed. Additionally, the anecdotal association of sugammadex with NPPE is outlined.

Keywords

• negative pressure pulmonary edema; non-cardiogenic pulmonary edema; hypoxemia; laryngospasm; sugam- madex