Negative Pressure Pulmonary Edema After General Anesthesia

Abstract Negative pressure pulmonary oedema is a type of non-cardiogenic pulmonary oedema caused by strong inspiratory effort to overcome obstruction in the upper airways. The main mechanisms responsible for the pathophysiology are the increase in pulmonary capillary hydrostatic pressure and the increase in capillary membrane permeability that develops after the negative intrathoracic pressure increases with inspiratory effort. Although all causes that may lead to upper airway obstruction may play a role in the etiology, the most common factor is laryngospasm that develops during awakening from anaesthesia. Young male smokers under general anaesthesia are more at risk. Onset may vary from a few minutes to several hours after extubation or relief of laryngospasm. It leads to an acute respiratory failure that is potentially life-threatening and usually requires follow-up and treatment in the intensive care unit. The first step in treatment is to relieve airway obstruction and provide oxygen support. Positive pressure ventilation and use of diuretics are beneficial and usually tend to improve within 24-48 hours. The mortality rate is reported to be around 5% in case analysis reports of recent years. Since it is observed more frequently in anaesthetised patients, early diagnosis and treatment in the postoperative period is important. The aim of this review is to present a current perspective on negative pressure pulmonary oedema in the light of the literature.