Postoperative pulmonary edema in young, athletic adults
Pulmonary edema secondary to postextubation laryn gospasm is a potentially life-threatening problem, de manding early diagnosis and prompt treatment. We believe that this problem has been grossly underesti mated in its incidence, as only seven adults have been reported in the English literature, whe...
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Veröffentlicht in: | The American journal of sports medicine 1991-07, Vol.19 (4), p.365-371 |
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Zusammenfassung: | Pulmonary edema secondary to postextubation laryn gospasm is a potentially life-threatening problem, de manding early diagnosis
and prompt treatment. We believe that this problem has been grossly underesti mated in its incidence, as only seven adults
have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month
period. All were young, healthy, athletic adult males (average weight, 218 pounds) who underwent relatively minor, uncomplicated
surgical procedures under gen eral anesthesia.
Five of these patients were collegiate and/or profes sional athletes and had meticulous medical records detailing their clinical
course. Clinical laryngospasm was noted immediately following extubation and anesthesia by mask with subsequent pulmonary
edema. The di agnoses were confirmed by clinical examination, arterial blood gas determinations or pulse oximetry, and chest
roentgenogram. Four adults required reintubation. Six of the seven adults demonstrated very rapid resolution of the pulmonary
edema with prompt diagnosis and institution of a therapeutic regimen including oxygen, diuretics, reintubation, and/or positive
pressure venti lation. In one patient, the problem was not immediately recognized, and progressed to florid pulmonary edema
requiring emergent intubation 14 hours later in the emergency room, and 3 days of mechanical ventilation.
The etiology of pulmonary edema following upper airway obstruction represents an interplay between several factors: cardiogenic
and neurogenic mecha nisms, as well as hypoxia contribute. In this group, excessive negative intrathoracic pressure generated
by forced inspiration against a closed glottis is the most likely, consistent, and logical explanation.
This study suggests that young, healthy, athletic males may be at increased risk for this complication. We believe that their
enhanced ability to generate ex cessive negative intrathoracic pressures is, at least in part, responsible. A heightened awareness
of the prob lem in this at-risk group should invoke special consid erations, including choice of anesthesia, precautions on
extubation, prolonged monitoring in the recovery phase if laryngospasm is observed or suspected, and rapid therapeutic intervention. |
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ISSN: | 0363-5465 1552-3365 |
DOI: | 10.1177/036354659101900407 |