Airway obstruction caused by massive swelling of the tongue following bilateral tonsillectomy for sleep apnea syndrome

: A case of airway obstruction caused by the tongue swelling is reported. The patient is a 5-year-old boy scheduled for bilateral tonsillectomy for sleep apnea syndrome. Anesthesia was slowly induced by sevoflurane and maintained with nitrous oxide, fentanyl and sevoflurane. Bilateral tonsillectomy and adenoidectomy were performed uneventfully under general anesthesia. The operation time was 2 hours and 30 minutes. Following the surgical procedure, the endotracheal tube was removed. Shortly after the extubation, the patient complained of difficult articulation and paradoxical respiration. Trachea was intubated immediately. Oxygen saturation was within normal limits throughout all the procedures. Swelling of the tongue was aggravated and was not relieved by steroid infusion. Massive swelling of the face and neck was observed on the next day. CT scan and fiberoptic scope examination showed the swollen tongue obstructing the upper airway. Additional administration of steroid was continued. On the third postoperative day, edema was relieved and the endotracheal tube was removed. Clinical course after the extubation was uneventful. No laboratory data was obtained suggesting the allergic basis. Extubation should be performed carefully and respiratory condition should be observed cautiously following the oral surgery of even a short duration.