title: Negative pressure pulmonary oedema following adenoidectomy under general anaesthesia: a case series.
abstract: BACKGROUND
  Negative pressure pulmonary oedema (NPPE) is a potentially life-threatening complication of laryngospasm that occurs during or after general anaesthesia. It is a complication of poorly treated or unrecognized laryngospasm occurring at extubation or later in the postoperative period.
  
  
  OBJECTIVE
  To emphasize prompt recognition of laryngospasm during or after general anaesthesia and to prevent its progression to NPPE in a resource-challenged environment.
  
  
  METHODS
  Three children aged two to four years, one of whom was a known sickle cell anaemia patient presented with adenoid hypertrophy. Surgery was postponed on account of upper respiratory tract infection in each of them.
  
  
  RESULTS
  Following treatment of upper respiratory tract infection, they had adenoidectomy under general anaesthesia. They all developed severe laryngospasm at extubation. This progressed to NPPE which was diagnosed on clinical parameters. The children were subsequently admitted to the intensive care unit (ICU) for mechanical ventilation with high FiO2 (0.7-1) and PEEP between 12-24hours. While two of the children survived, the child with sickle cell anaemia died in the ICU.
  
  
  CONCLUSIONS
  Negative pressure pulmonary oedema is a self limiting complication of laryngospasm if it is well managed. However, its outcome may not be good in a patient with intercurrent medical illness such as sickle cell anaemia in which hypoxaemia is deleterious.
authors: Department of Anaesthesia, University of Ilorin, Ilorin, Nigeria. olubolajidr@unilorin.edu.ng
authors: B O
authors: BO
authors: Bolaji
authors: O O
authors: OO
authors: Oyedepo
authors: A D
authors: AD
authors: Dunmade
authors: O A
authors: OA
authors: Afolabi
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000601:surgery*; D000768:Anesthesia, General / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007826:Laryngismus / Q000209:etiology*; D008297:Male; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications; D011312:Pressure; D011654:Pulmonary Edema / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome