[Case of pulmonary edema and transient heart failure during difficult airway management]

Many kinds of side effects are likely to occur while managing difficult airway. This article describes a case of a man who fell into pulmonary edema and heart failure during the difficult airway management. He was to undergo arthroscopic surgery on his knee. At first, we planed spinal anesthesia but he took an antiplatelet drug (aspirin). Since we wanted to avoid the epidural hematoma, we chose general anesthesia. After induction of general anesthesia, positive pressure ventilation via face mask was possible, but laryngeal mask ventilation was impossible. Although tracheal intubation was attempted, we recognized that he had difficult airway. After some intubation trials, we decided to quit the operation and awoke the patients. Spontaneous breathing appeared soon, but the oxygenation was getting worse. We performed fiberoptic nasal intubation under spontaneous breathing. Although his blood pressure was quite high during intubation, after intubation the vasopressor was needed to maintain blood pressure. Ventilation with 100% O2 could not maintain the oxygenation well. Chest X-ray revealed the pulmonary edema. We presumed that hypertension associated with airway stimulation had caused acute pulmonary edema and heart failure resulting from diastolic dysfunction induced by increased catecholamine.