Anesthesia and Airway Obstruction
We read with interest the recent case report and review of post- obstructive pulmonary edema by Willms and Shure. A recent case at our hospital prompted a review of the anesthesia-related literature.
We note that these authors implicate post-anesthesia laryngo- spasm as the most common cause of this syndrome in adults. Although they reported that the majority of patients were free of diseases predisposing to pulmonary edema, they did not comment on the presence of factors which might increase the risk of airway obstruction in the anesthesia-related subgroup.
In 1986, Lorch and Sahn reviewed eight adult case reports of post-obstructive pulmonary edema associated with anesthesia. These authors identified factors predisposing to perioperative airway obstruction in six cases. These factors included: 1) anatomically difficult intubation; 2) nasal, oral or pharyngeal surgical site or pathology; and 3) obesity with obstructive apnea.
Five of seven additional anesthesia-related case reports reviewed by Willms and Shure also involved predisposing factors similar to those identified by Lorch and Sahn. Thus, although this syndrome can follow episodes of uncomplicated laryngospasm, it appears that the majority of anesthesia-related cases involved additional identifiable factors which increased the risk of perioperative upper airway obstruction. Cialis Jelly
We agree that this syndrome deserves greater recognition particularly among those involved in perioperative patient care. The administration of anesthesia and the performance of tracheal intubation and extubation are always associated with a risk of upper airway obstruction. Recognition of the specific risk factors which have been identified in the majority of anesthesia-related case reports of this syndrome should assist in heightening our vigilence and hopefully avoiding some of the complications associated with airway management in the perioperative patient.