Allergy Asthma Respir Dis.  2022 Oct;10(4):229-232. 10.4168/aard.2022.10.4.229.

Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy

• Kim HJ
• Park SK

• KMID: 2534612
• DOI: http://doi.org/10.4168/aard.2022.10.4.229

Abstract

A 9-year-old child with cerebral palsy developed negative-pressure pulmonary edema (NPPE) followed by upper airway obstruction, which may be attributable to laryngospasm during recovery from general anesthesia. Therefore, the patient underwent repeat endotracheal intubation and was transferred to the intensive care unit. Mechanical ventilation and positive-pressure end-expiratory pressure led to resolution of pulmonary edema. The endotracheal tube was removed 1 day postoperatively, and the patient was discharged without sequelae. NPPE is rare in children and self-limited; however, delayed diagnosis and lack of appropriate treatment may be fatal. Notably, administration of general anesthesia to patients with cerebral palsy is associated with difficulty in airway intubation, decreased ventilatory function, aspiration of gastric contents, slow recovery from anesthesia, and anesthesia-induced adverse effects. Therefore, careful anesthesia management is warranted in children with cerebral palsy. In this case report, we describe the essential precautions during administration of general anesthesia to children with cerebral palsy and the pathophysiology, diagnosis, and treatment of NPPE, together with a literature review.

Keyword

Cerebral palsy; Negative pressure pulmonary edema; General anesthesia; Pediatric