[Pulmonary edema due to laryngospasm immediately after extubation].

We describe a case of negative pressure pulmonary edema (NPPE) followed by laryngospasm occurred immediately after extubation. A 56-year-old man with a tumor at the site of ureteroneocystostomy underwent left ureterectomy and partial resection of the neobladder under general anesthesia. The tracheal intubation was difficult with glade 3 of Cormack classification. Anesthesia was maintained with sevoflurane, nitrous oxide, and oxygen. After fully awake extubation, the upper airway obstruction due to laryngospasm was observed. A nasal airway was inserted, but face mask ventilation was impossible. Ventilation became possible with SpO2 of around 40%, and spontaneous respiration appeared. The patient was nasally intubated with a fiberoptic bronchoscope. Furosemide was administered in ICU and mechanical ventilation with 5cmH2O PEEP was started. Seventeen hours later, the pulmonary edema disappeared and he was successfully extubated without any complications. It was warned that laryngospasm would occur even after the full emergence, leading to NPPE.

Perioperative management of obstructive sleep apnea with nasal continuous positive airway pressure.

The high risks associated with general anesthesia in obstructive sleep apnea syndrome (OSAS) patients have been reported. Many authors have suggested that the intraoperative administration of opioids and sedatives should be limited or avoided because these drugs selectively impair muscle activity in the upper airway. We report the case of an OSAS patient who was managed with nasal continuous positive airway pressure (NCPAP) and treated safely in spite of the use of conventional anesthetic and analgesic agents typically used for patients without OSAS. She had little pain during the perioperative period. It is suggested that NCPAP is an effective treatment for not only preventing airway obstructive apnea but for allowing the administration of anesthetic and analgesic drugs without major complications.