Delayed Onset Negative Pressure Pulmonary Edema after General Anesthesia in a Young Man

Abstract

Negative pressure pulmonary edema (NPPE) is a form of non-cardiogenic pulmonary edema. NPPE usually arises as a consequence of upper airway obstruction during emergence from general anesthesia. Most cases develop symptoms within minutes following the inciting event. Delayed onset is uncommon. Here we describe a patient where negative pressure pulmonary edema occurred in a young schoolboy. It was induced by post-extubation laryngospasm after general anesthesia, but it had a postoperative delayed onset of up to 4 hours. Delayed onset NPPE can impose challenges in terms of differential diagnosis and treatment. It should be considered as a risk for any patient with a history of upper airway obstruction. We hope this case report will heighten alertness to this uncommon condition and serve as a reminder to physicians and nurses who care for post-anesthesia patients in other medical units. Such awareness should help to prevent any delay in diagnosis and treatment.