Acute noncardiogenic pulmonary edema during spontaneous respiratory recovery after tonsillectomy in the endotracheal intubation state

So Hui Yun, Woo Jin Cho, Seung Yeon Cho, Seung Eun Song, Changrock Kna


Acute pulmonary edema during the perioperative period can have various causes. A 20-year-old woman was admitted for tonsillectomy and adenoidectomy. She had nasal congestion since 2 months, chronic sinusitis with polyps, and diffuse lymphoid hyperplasia. A biopsy and peripheral blood smear were performed to rule out a lymphoma before surgery. We injected neostigmine 1.5 mg and glycopyrrolate 0.4 mg at the end of the surgery. Two minutes later, the secretion and peak airway pressure increased as well as the CO2 levels. The patient remained sedated and suctioning continued for approximately 20 minutes prior to extubation. The secretions reduced and there was an improvement in clinical symptoms, as the pinkish foamy pattern became whitish. Presumed treatment of neostigmine hypersensitivity or surgery can be used to resolve perioperative chronic partial airway obstruction.


Drug hypersensitivity; General anesthesia; Neostigmine; Pulmonary edema; Tonsillectomy


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