title: [Successful extubation in a patient with alacepril-induced tongue angioedema].
abstract: We describe a case of marked swelling of the tongue in a patient after a long prone position neurosurgery, who was treated for hypertension with alacepril. The tongue was not congestive and history of taking an angiotensin-converting enzyme inhibitor suggested an alacepril-induced angioedema. The day after surgery, the patient's tongue was still swollen; however, fibrescopic observation of the larynx and pharynx through the nasal cavity revealed that the edema was limited to anterior tongue, and the oral cavity and oropharynx were not involved. Although, tongue angioedema was observed, we introduced a 3-mm tube exchanger to the patient's trachea and removed the endotracheal tube. The ventilation and oxygenation were maintained, and 30 min later, the exchanger was detached. On the second postoperative day, the angioedema disappeared completely and the patient was transferred to a ward without any complication.
authors.affiliation: Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Katoh
authors.forename: Taiga
authors.initials: T
authors.lastname: Itagaki
authors.forename: Katsumi
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yukako
authors.initials: Y
authors.lastname: Obata
authors.forename: Yushi
authors.initials: Y
authors.lastname: Adachi
authors.forename: Matsuyuki
authors.initials: M
authors.lastname: Doi
authors.forename: Shigehito
authors.initials: S
authors.lastname: Sato
mesh_terms: D000758:Anesthesia; D000799:Angioedema / Q000139:chemically induced*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D002216:Captopril / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D019635:Neurosurgical Procedures; D019990:Perioperative Care; D011183:Postoperative Complications / Q000139:chemically induced*; D016684:Prone Position; D014060:Tongue Diseases / Q000139:chemically induced*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril; C046835:alacepril