Pulmonary edema and hemorrhage as complications of acute airway obstruction following anesthesia

Abstract

Airway obstruction is a quite common complication while its conditioned pulmonary edema – rare. Causes associated with anesthesia are various. Forced inspiratory efforts against an obstructed upper airway generate peak negative intrathoracic pressure. This may cause pulmonary edema and in some cases pulmonary hemorrhage. Last-mentioned is extremely rare. Pulmonary edema may arise soon after airway obstruction as well as later, after some hours. Damage of bronchi is found seldom during bronchoscopy in case of pulmonary hemorrhage, while more often alveolar damage is observed due to alveolar membrane damage. Hemorrhage is conditioned by hydrostatic pressure level, level of hypoxia, damage to bronchi or alveoli (disruption of alveolar membrane). Early diagnosis of negative-pressure pulmonary edema or pulmonary hemorrhage is very important, because this affects postoperative morbidity and mortality of the patients. Two cases of pulmonary edema and hemorrhage after upper airway obstruction as well as literature overview are presented in this article. Pulmonary hemorrhage developed during anesthesia with ketamine, conditioned by increment of hydrostatic pressure, hypoxia, and effects of ketamine on hemodynamics.