Negative pressure pulmonary edema after a tonsillectomy and adenoidectomy in a pediatric patient: case report and review.

Negative pressure pulmonary edema (NPPE) continues to be reported as a complication of upper airway obstructions seen by anesthesia providers during induction or emergence. The majority of patients reported to have experienced NPPE have been healthy, without underlying pulmonary or cardiac disease. Factors associated with the formation of NPPE include young male patients and patients with long periods of airway obstruction. Overzealous intraoperative fluid administration and preexisting heart and lung disease also have been implicated as predisposing factors. Negative pressure pulmonary edema is the result of a marked decrease in intrathoracic pressure caused by ventilatory efforts against a closed glottis resulting in a disruption of the normal intravascular Starling mechanism, ultimately leading to the transudation of intravascular proteins and fluid into the pulmonary interstitium. The onset of NPPE is usually rapid, and without prompt recognition and intervention, the outcome can be fatal. A case of NPPE in a pediatric patient after an otherwise uncomplicated surgical procedure was observed in our institution and is described in this report.