A life-threatening complication at non-operating room anesthesia (NORA): - Negative pressure pulmonary edema after minimal dose of sedation in a postoperative case of reconstructive maxillofacial surgery

Patients with reconstructive maxillofacial surgery and flap cover have high risk of upper airway obstruction due to reconstructive surgery and the risk is further increased during sedation. A brief understaning of the mechanism and its preparedness to deal with the situation is the key for a better outcome. Management of anesthesia at remote location or Non-operating room anesthesia (NORA) itself is a challenge to the anesthesiologist in view of limited staff with less experience and also lack of advanced airway gadgets. In such a scenario, administration of even minimal sedative medication can be life threatening. We report a case of negative pressure pulmonary edema in a 57 year old aged patient who has come to hospital for follow up and was advised MRI. As patient was not cooperative, sedation was given with the intention to complete the MRI but landed up in respiratory distress. We managed in terms of negative pressure pulmonary edema, ventilated overnight and extubation was done next day. Patient was stable and discharged on third day.