title: Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention.
abstract: OBJECTIVE
  To provide rhinologic surgeons with an understanding of acute negative-pressure pulmonary edema (NPPE) and its treatment.
  
  
  METHODS
  Case report and literature review of all published adult cases of NPPE. Patient factors, anesthetic variables, and outcomes are assessed.
  
  
  RESULTS
  A total of 146 cases in 45 case reports and series were compiled. There was approximately a 2:1 male-female patient ratio. The average age of the patients was 33 years. Fifty percent of patients had surgery on the upper aerodigestive tract, and 8% had intranasal surgery. No patients received laryngotracheal anesthesia, and 5 of the 146 received intravenous lidocaine prior to extubation. One patient had NPPE following laryngeal mask airway treatment, and 2 patients experienced this complication after conversion from monitored anesthesia care to general endotracheal anesthesia; 33.5% of patients were treated with continuous positive airway pressure alone, while 66.5% required intubation and mechanical ventilation. The average time to resolution was 11.75 hours. Three patients died.
  
  
  CONCLUSIONS
  It is known that surgical procedures involving the upper aerodigestive tract have a higher risk of NPPE than other procedures. Rapid diagnosis and treatment is necessary to achieve early resolution and avoid significant patient morbidity. A thorough understanding is integral to the practice of nasal and paranasal sinus surgery, especially with the rising use of outpatient and office-based surgical suites. Therefore, we present a review of pathophysiologic mechanisms, possible risk factors, treatment options, and potential steps that can be taken to minimize this potentially devastating complication of general anesthesia.
authors.affiliation: Department of Otolarynogology, Mount Sinai Hospital, New York, NY 10029, USA. westrr01@yahoo.com
authors.forename: Richard
authors.initials: R
authors.lastname: Westreich
authors.forename: Ian
authors.initials: I
authors.lastname: Sampson
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Shaari
authors.forename: William
authors.initials: W
authors.lastname: Lawson
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D012225:Rhinoplasty / Q000009:adverse effects*