Postobstruction Pulmonary Edema

Case Synopsis

A 37-year-old, 77-kg, previously healthy man develops laryngospasm immediately after tracheal extubation, after an otherwise uneventful general anesthetic for repair of orbital floor fracture. Laryngospasm is managed with intravenous administration of succinylcholine after an unsuccessful attempt at bag-mask positive pressure ventilation. Fifteen minutes later he breathes spontaneously, with adequate tidal volume, but he coughs, his O ₂ saturation is 92% while breathing O ₂ via a nonrebreathing facemask, and his heart rate is 110 beats per minute. Lung auscultation reveals diffuse coarse rales. A chest radiograph demonstrates acute bilateral pulmonary edema and a normal cardiac silhouette.