Negative-pressure pulmonary oedema following upper airway obstruction after tracheal extubation in an adolescent undergoing general anaesthesia for dental extractions.

A healthy athletic adolescent male with a remote history of asymptomatic childhood asthma underwent outpatient multiple molar extractions under general anaesthesia with tracheal intubation. Shortly after gentle tracheal extubation, he developed acute upper airway obstruction with oxygen desaturation and increased work of breathing, despite careful oropharyngeal aspiration and confirmed reversal of neuromuscular blockade. Initial airway manoeuvres and face-mask ventilation with 100% oxygen against high airway resistance provided only transient improvement, requiring tracheal re-intubation and positive-pressure ventilation. Following subsequent uneventful tracheal extubation, he developed recurrent respiratory distress in the post-anaesthesia care unit, characterised by biphasic stridor, bilateral crackles and scant frothy secretions. As cardiogenic causes were excluded by transthoracic echocardiography, the clinical presentation was consistent with negative-pressure pulmonary oedema. Supportive management, including supplemental oxygen, careful fluid balance and diuretic therapy under close monitoring, resulted in progressive clinical improvement. The patient made a full recovery and was discharged 24 hours postoperatively.