Negative-pressure Pulmonary Edema Following Sustained Laryngospasm during Emergence from Anesthesia in a Young Adult Undergoing Facial Surgery: A Case Report

Post-extubation negative-pressure pulmonary edema (NPPE) develops after the closed intrathoracic cavity was forced to expand with intense inspiratory effort against an obstructed airway. Laryngospasm that occurs after extubation during emergence is one of the causes of upper airway obstruction. Extubation during an inadequate depth of anesthesia, excessive airway secretion and irritation due to suction are known as cause of laryngospasm. Recently, there have been reports that laryngospasm occurred after sugammadex administration during emergence from general anesthesia. Here, we report NPPE following consecutive sugammadex administration during emergence from anesthesia in a young man undergoing nasal septorhinoplasty under general anesthesia. In this case, NPPE occurred due to an excessive increase in inspiratory force in the state of airway obstruction (laryngospasm) after extubation, and a young man, nasal surgery with packing, and repeated misuse of sugammadex due to absence of neuromuscular monitoring could contribute to the occurrence of NPPE.