[Snoring and postoperative pulmonary edema]

„Negativdruck-Lungenödem“ und „alveoläre Hämorrhagie“ als Komplikationen einer oberen Atemwegsobstruktion

Negativdruck-Lungenödem und alveoläre Hämorrhagie sind lebensbedrohliche Komplikationen infolge einer akuten oberen Atemwegsobstruktion. Durch die Obstruktion im Larynx-/Pharynbereich kommt es zu hohen negativen Intrapleuraldrucken, die sich, durch unterschiedliche Faktoren bedingt, auf die Integrität der alveolo-kapillären Membran auswirken. In der Übersichtsarbeit werden klinische Symptome, Ätiologie, die Pathophysiologie sowie die therapeutischen Optionen beschrieben. Ziel ist es, den Kliniker mit den Krankheitsbildern und den Komplikationen vertraut zu machen.

[Negative pressure pulmonary edema after peritonsillar abscess tonsillectomy]

We report on a 19-year-old patient who developed negative pressure pulmonary edema (NPPE) with respiratory insufficiency following abscess tonsillectomy. NPPE is an unpredictable and life-threatening postoperative complication characterized by respiratory insufficiency. It may arise immediately after extubation or later in the postoperative period. NPPE is frequently observed after laryngospasm or in combination with space-occupying lesions in the pharynx and larynx. Treatment comprises the immediate correction of hypoxemia, preferably by noninvasive respiratory support using continuous positive airway pressure (CPAP), although in some cases reintubation is necessary.

Respiratory complications associated with anesthesia

Adverse pulmonary outcomes that follow anesthesia and surgery are often attributed to anesthesia care. PPCs are a significant concern for anesthesia caregivers because they use drugs and techniques that temporarily decrease lung volume, impair airway reflexes, limit immune function, and depress secretion mobilization. A significant component of perioperative risk derives from the surgical site, postoperative pain, and effects of pharmacologic pain management. Rapidly evolving surgical and anesthesia techniques and the introduction of newer pharmaceutical agents make it difficult to identify best practice from retrospective experience reported in the perioperative literature. Prospective studies that deal with specific patient populations, incomparable patient groups or techniques, and unique practice bias have limited validity of claims regarding several promising approaches to perioperative risk reduction. In the absence of clear scientific principles, a perioperative pulmonary risk management strategy for the early part of this century is based on the consensus practice of informed clinicians (Box 4).