Pulmonary Oedema following Acute Upper Airway Obstruction

Key Words: PULMONARY OEDEMA: airway obstructionNon-cardiogenic pulmonary oedema is uncommon, and may arise from a variety of causes, including drugs, sepsis, head trauma and high altitude.Below two cases of asphyxial pulmonary oedema are described and previous reports in the literature and prevailing theories of pathogenesis are reviewed. CASE REPORTSCase I: A 16-year-old male caucasian with known dextrocardia was admitted to hospital for bilateral intranasal antrostomy.General anaesthesia was uneventful after induction with thiopentone 350 mg intravenously (IV) and alcuronium 15 mg IV with fentanyl maintenance doses to a total of 100 JAg.Two minutes after extubation he developed severe laryngeal spasm causing complete respiratory obstruction and cyanosis.He was immediately reintubated without drugs, and was ventilated using 100070 oxygen.Vital signs were normal and oxygenation appeared satisfactory.When spontaneous respiration was allowed to return, copious pink frothy sputum issued from his airway, whereupon mechanical ventilation was reinstituted.