Neostigmine: an unusual cause of post-operative non-cardiogenic pulmonary oedema

Abstract

Non cardiogenic pulmonary oedema (NCPE) continues to represent an important cause of morbidity and mortality with a large human and financial cost. Because of the resemblance of the clinical picture to that seen with respiratory distress of the neonate, NCPE has been referred to as the Adult Respiratory Distress Syndrome (ARDS). In spite of the great improvement in supportive therapy, mortality continues to exceed 50%. The diagnosis of drug-related NCPE relies upon documented exclusion of other causes of NCPE like gastric aspiration, sepsis, trauma, negative pressure pulmonary oedema, etc. We describe cases of 55-year old male who underwent an elective surgery under general anaesthesia and developed NCPE after administration of ‘neostigmine-glycopyrrolate’ used to reverse residual neuromuscular blockade. The patient was treated successfully with mechanical ventilatory support, and adjuvant therapy. This report emphasizes that this fatal complication may be seen with neostigmine, the pathogenic mechanism remains unknown, and it probably is a drug-related NCPE.