Negative-pressure pulmonary edema after transsphenoidal hypophysectomy. Case report.
OBJECTIVE
Negative-pressure pulmonary edema (NPPE) is a rare complication that evolves rapidly after acute or chronic obstruction of the airways. The objective of this report was to present a case of NPPE after upper airways obstruction in a patient with acromegaly who underwent transsphenoidal hypophysectomy.


METHODS
A 48 years old male patient, weighing 80 kg, physical status ASA III, with a tumor in the hypophysis, hypertension, and acromegaly, underwent transsphenoidal hypophysectomy under general balanced anesthesia. The surgery proceeded without intercurrences. The patient was extubated while in a superficial anesthetic plane. He developed difficulty breathing, retraction of the abdominal wall, severe hypoxemia (SpO2 30%), unconsciousness, and cardiac arrhythmia (PVCs and bradycardia). Positive-pressure ventilation with a face mask and oropharyngeal cannula was ineffective. The patient was intubated and, at this moment, there were bilateral pulmonary rales and frothy pinkish secretion inside the tracheal tube, compatible with NPPE. The patient was transferred to the ICU and remained on mechanical ventilation for 96 hours. He was discharged to the regular ward on the 5th postoperative day without neurological sequelae.


CONCLUSIONS
Negative-pressure pulmonary edema may occur in the immediate postoperative period of transsphenoidal hypophysectomy. Immediate diagnosis and treatment are essential for early resolution of the process and to decrease morbidity.
Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG. vivialbergaria@yahoo.com.br
Viviane Ferreira
VF
Albergaria
Carla Márcia
CM
Soares
Rodolfo de Moraes
Rde M
Araújo
Washington Luiz
WL
de Mendonça
D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology*