Post-extubation Negative Pressure Pulmonary Edema Complicating Laparoscopic Appendicectomy: A Case Series

Background: Negative pressure pulmonary edema (NPPE) is a rare but potentially life-threatening form of non cardiogenic pulmonary edema that occurs following acute upper airway obstruction, most commonly after post extubation laryngospasm. Although uncommon after laparoscopic appendicectomy, NPPE requires prompt recognition and management to prevent significant morbidity. Case Presentation: We report a case series of five patients who developed post-extubation negative pressure pulmonary edema following laparoscopic appendicectomy under general anesthesia. All patients experienced acute respiratory distress immediately after extubation, with clinical manifestations including hypoxemia, tachypnea, bilateral coarse crepitations, and, in some cases, pink frothy sputum. Chest radiography demonstrated bilateral diffuse pulmonary infiltrates consistent with non-cardiogenic pulmonary edema. Differential diagnoses such as aspiration pneumonitis, cardiogenic pulmonary edema, and fluid overload were excluded based on clinical evaluation and appropriate investigations. Management consisted of immediate airway stabilization, administration of supplemental oxygen, positive pressure ventilation using continuous positive airway pressure (CPAP) or mechanical ventilation with positive end-expiratory pressure (PEEP), and supportive intensive care measures. All patients showed rapid clinical improvement with complete radiological resolution within 24–48 hours and were discharged without long term pulmonary complications. Conclusion: Post-extubation NPPE is an uncommon but reversible perioperative emergency that should be suspected in patients who develop sudden respiratory distress immediately after extubation. Early diagnosis, prompt restoration of airway patency, and timely ventilatory support are essential for favorable outcomes. This case series highlights the importance of vigilant postoperative airway monitoring and increased awareness among anesthesiologists and perioperative care teams to facilitate early recognition and successful management of this rare complication. Keywords: Negative pressure pulmonary edema; Post-extubation pulmonary edema; Laryngospasm; General anesthesia; Laparoscopic appendicectomy; Upper airway obstruction; Non-cardiogenic pulmonary edema; Mechanical ventilation; Perioperative complication; Case series.