Open AccessPostobstructive pulmonary edema (POPE) after surgery for obstructive sleep apnea
Author(s) -
Chang KaiChen,
Li HsuehYu
Publication year - 2013
Publication title -
the kaohsiung journal of medical sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.439
H-Index - 36
eISSN - 2410-8650
pISSN - 1607-551X
DOI - 10.1016/j.kjms.2012.09.009
Subject(s) - medicine , uvulopalatopharyngoplasty , anesthesia , obstructive sleep apnea , pulmonary edema , airway , intubation , surgery , apnea , lung , polysomnography
The mechanism of developing postobstructive pulmonary edema (POPE) involves fluid shifting to the pulmonary interstitium owing to changes in intrathoracic pressure. Negative intrathoracic pressure is generated in the pulmonary cavity when the patient attempts to inspire against an obstructed airway. The drop in intrathoracic pressure causes increased venous return and pulmonary venous pressure, which creates a hydrostatic transpulmonary gradient with the fluid shifting from the pulmonary venous system to the pulmonary interstitium [1]. In general, it is thought to occur in 0.05e0.1% of all procedures involving intubation and general anesthesia [2]. A 39-year-old man came to our clinic for snoring and excessive daytime sleepiness for several years. A physical examination showed bilateral tonsil enlargement (Grade 3), narrowing of the retropalatal space, and nasal septum deviation with chronic hypertrophic rhinitis. Preoperative polysomnography revealed an apneaehypopnea index of 38.9 events/h, which indicated severe obstructive sleep