Case reportTongue swelling in the recovery room: a case report and discussion of postoperative angioedema
Introduction
Postoperative swelling of the tongue is a rare but potentially life-threatening situation. Cases of angioedema occurring in a patient on angiotensin-converting enzyme (ACE) inhibitor therapy after airway manipulation have been reported [1], [2], [3], [4], [5]. However, postoperative angioedema secondary to ACE inhibitor therapy has largely been overlooked by anesthesiologists. This may result in delayed recognition and unnecessary surgical airways [6]. We present a case of swelling in the tongue and oropharynx, which developed in the postanesthesia care unit (PACU). Differential diagnoses of tongue and oropharynx swelling along with appropriate therapeutic interventions are discussed.
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Case report
A 51-year-old, 63-kg, 161-cm, African-American woman presented for an uvulopalatopharyngoplasty and bilateral tonsillectomy for obstructive sleep apnea. Her past medical history was significant for tobacco abuse, asthma, hypertension, diabetes mellitus, and gastroesophageal reflux disease. Her medications included inhaled albuterol, salmeterol, and fluticasone daily as well as lisinopril, metformin, esomeprazole, and estrogen. Her past surgical history included an uneventful hysterectomy and
Discussion
The differential diagnosis of postoperative tongue swelling includes angioedema, allergic reaction and anaphylaxis, hematoma formation, and tongue congestion secondary to traumatic or prolonged compression during surgery. Our patient's presentation was devoid of systemic symptoms, hypotension, or dermatologic manifestations seen during an allergic or anaphylactic reaction. A discrete, hard, discolored mass was not present to indicate a hematoma had formed. Tissue congestion caused by the
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