Abstract
Case 1: The patient, a 73-year-old male with early hypopharyngeal cancer, underwent endoscopic mucosal resection (EMR) under general anesthesia. Coming out from under the anesthetic, the patient was extubated in the operating room. Then, he suddenly developed severe inspiratory stridor, followed by tachypnea, and began to complain strongly of dyspnea. Case 2: The patient, a 67-year-old male with early hypopharyngeal cancer, underwent EMR under general anesthesia. Immediately after extubation following successful surgery, the patient developed respiratory distress with vigorous inspiratory efforts. Because severe laryngo-pharyngeal edema was found in both cases, these tracheae were orally re-intubated under direct laryngoscopy. Both patients were transferred to the intensive care unit (ICU). In case 2, chest X-rays immediately after re-intubation revealed bilateral diffuse alveolar infiltration. The diagnosis was interstitial pulmonary edema. The lung edema was considered to be induced by strong inspiratory efforts. The patient required mechanical ventilatory support in ICU for several days. It was strongly recommended that the entire laryngo-pharyngeal space be examined at the completion of hypopharyngeal endoscopic mucosectomy before extubation. If any signs of laryngo-pharyngeal edema exist, the endotracheal tube was to be left in place and the patient carefully observed in the ICU until the next morning.
