Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology Patient

Context: Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II). Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea. Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003. Setting: Tertiary care teaching hospital and its affiliates. Patients: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years. Results: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities. Conclusion: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery.