Successful extubation in a patient with alacepril-induced tongue angioedema
Katoh, H.; Itagaki, T.; Suzuki, K.; Obata, Y.; Adachi, Y.; Doi, M.; Sato, S.
Masui. Japanese Journal of Anesthesiology 59(4): 519-522
2010
ISSN/ISBN: 0021-4892 PMID: 20420150 Document Number: 642740
We describe a case of marked swelling of the tongue in a patient after a long prone position neurosurgery, who was treated for hypertension with alacepril. The tongue was not congestive and history of taking an angiotensin-converting enzyme inhibitor suggested an alacepril-induced angioedema. The day after surgery, the patient's tongue was still swollen; however, fibrescopic observation of the larynx and pharynx through the nasal cavity revealed that the edema was limited to anterior tongue, and the oral cavity and oropharynx were not involved. Although, tongue angioedema was observed, we introduced a 3-mm tube exchanger to the patient's trachea and removed the endotracheal tube. The ventilation and oxygenation were maintained, and 30 min later, the exchanger was detached. On the second postoperative day, the angioedema disappeared completely and the patient was transferred to a ward without any complication.