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Medical Science Monitor Basic Research


Negative pressure pulmonary edema (NPPE) after discectomy in general anesthesia with endotracheal intubation: case report

B. Cagla O. Akkurt, Alper Kararmaz, Kerem Inanoglu, Yurdal Serarslan

CaseRepClinPractRev 2006; 7:209-211

ID: 456837

Available online:


Background: Negative-pressure pulmonary edema (NPPE) is a rare and serious complication after general
anesthesia. Although it is generally seen after upper airway surgery, it can be seen in different types of surgery also. We report a young, healthy case that developed pulmonary hemorrhage and alveolar edema after extubation of the trachea.
Case Report: A 27-year-old ASA II male with a history of smoking, underwent elective discectomy. Following
uneventful surgery under general anesthesia, the patient was taken to supine position. He developed a marked inspiratory effort and he bit the endotracheal tube during position changing. Immediately after extubation, the patient developed respiratory distress. Due to desaturation the patient was reintubated An intense hemorrhagic fluid was suctioned in the endotracheal tube. The chest radiograph showed bilateral pulmonary infiltrates.After 24 hours of mechanical
ventilation, the patient’s symptoms improved and he was extubated. He was discharged from the hospital on the fourth postoperative day.
Conclusions: Although it is rare, NPPE can be seen following operations other than upper airway surgery.

Keywords: negative-pressure pulmonary edema, pulmonary hemorrhage, general anesthesia