Negative Pressure Pulmonary Edema Related to Laryngospasm and Upper Airway Obstruction in a Patient With Treacher Collins Syndrome

Abstract

Laryngospasm is an uncommon complication of anesthesia in adults but more common in pediatric anesthesia, which could present similarly to supraglottic upper airway obstruction. The management of such airway complications is even more difficult in patients with difficult mask ventilation and intubation. Our case illustrated the management of laryngospasm and negative pressure pulmonary edema in a patient with Treacher Collins syndrome. A literature search revealed few previous similar reports. We demonstrated an algorithm to differentiate between the true laryngospasm from the supraglottic upper airway obstruction, the management of laryngospasm in patients with difficult airways, and the recognition and management of negative pressure pulmonary edema as a complication of laryngospasm.

Keywords: difficult airway algorithm; laryngospasm; negative pressure pulmonary edema; treacher-collins syndrome; upper airway obstruction.

Figure 1. Lateral profile of the patient with Treacher Collins syndrome

Figure 2. Anterior-posterior chest radiograph of the patient immediately after the surgery in the recovery unit.

Figure 3. Anterior-posterior chest radiograph of the patient on post-operative day 1.

Figure 4. An algorithm for the management of laryngospasm and supraglottic obstruction in adult patients with difficult mask ventilation and difficult intubation.

ETCO₂ – End-tidal carbon dioxide; O₂ - Oxygen; CPAP - Continuous positive airway pressure; IV - intravenous; IM - intramuscular; ALS - Advanced Life Support; CPR - Cardiopulmonary Resuscitation; NG - nasogastric [2,9].