Negative pressure pulmonary oedema following adenoidectomy under general anaesthesia: a case series

Negative pressure pulmonary oedema (NPPE) is a potentially life-threatening complication of laryngospasm that occurs during or after general anaesthesia. It is a complication of poorly treated or unrecognized laryngospasm occurring at extubation or later in the postoperative period.

To emphasize prompt recognition of laryngospasm during or after general anaesthesia and to prevent its progression to NPPE in a resource-challenged environment.

Three children aged two to four years, one of whom was a known sickle cell anaemia patient presented with adenoid hypertrophy. Surgery was postponed on account of upper respiratory tract infection in each of them.

Following treatment of upper respiratory tract infection, they had adenoidectomy under general anaesthesia. They all developed severe laryngospasm at extubation. This progressed to NPPE which was diagnosed on clinical parameters. The children were subsequently admitted to the intensive care unit (ICU) for mechanical ventilation with high FiO2 (0.7-1) and PEEP between 12-24hours. While two of the children survived, the child with sickle cell anaemia died in the ICU.

Negative pressure pulmonary oedema is a self limiting complication of laryngospasm if it is well managed. However, its outcome may not be good in a patient with intercurrent medical illness such as sickle cell anaemia in which hypoxaemia is deleterious.