Delayed resolution of negative pressure pulmonary edema associated with low-molecular-weight dextran after microsurgery--a case report.

Negative pressure pulmonary edema (NPPE) is an uncommon perioperative complication after total or partial upper airway obstruction during anesthesia or respiratory distress. The cardinal event causative of the pathophy-siology is believed to be the generation of a sudden and marked negative intrapleural pressure against a closed glottis, resulting in a disruption of the normal intravascular Starling mechanism. Ultimately, excessive intravascular fluid which transudes into the interstitial space eventuates in pulmonary edema. In most reports, patients suffering from NPPE could recover within 24 h after appropriate treatment. Here, we report a case of highly suspected NPPE with delayed resolution associated with the perioperative use of dextran, following microsurgery for digital anastomosis of the nearly amputated right thumb. We have reviewed the possible pathomechanisms of NPPE, and discuss herein the possible relationship between the delayed resolution of NPPE and perioperative use of dextran.