• D Arnaud, J L Blache, C Courtinat, C Bouffier, and F Dubouloz.
• Ann Fr Anesth Reanim. 1987 Jan 1;6(1):42-4.

AbstractA case is reported of rapidly resolving pulmonary oedema following post-extubation laryngospasm in a 23 year-old healthy man who underwent emergency resection of a rectal polyp. The laryngospasm occurred immediately after extubation and resolved after administration of curare. The patient was reintubated and auscultation disclosed bilateral coarse and moist rales. Chest X-ray displayed a right pulmonary opacity. Because of the deteriorating respiratory status, mechanical ventilation was used with positive end-expiratory pressure for 18 h. Chest examination, chest X-ray and arterial blood gas levels improved steadily and the patient was discharged 24 h later. Pulmonary oedema associated with upper airway obstruction seems to be related to hypoxic pulmonary vasoconstriction and the largely subatmospheric transpulmonary pressure gradients generated while trying to breathe against a closed glottis. In addition, this increased negative intra-alveolar pressure was responsible for significant changes in cardiovascular function: right ventricular blood volume, right ventricular ejection fraction and left ventricular after-load increased, while left ventricular ejection fraction decreased. These changes favoured a rise in left atrial and pulmonary blood volumes, with transudation of fluid from the capillaries into the alveoli. Because of the severe consequences of respiratory failure, any patient who suffers acute upper airway obstruction should be observed in the recovery room for at least 3 h in order not to miss this rarely developing, but fortunately rapidly reversible, syndrome.

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