Life-threatening airway obstruction caused by angioedema in a morbidly obese postoperative patient: a case report

BackgroundWe report a case of a morbidly obese patient who developed life-threatening airway obstruction due to angioedema.Case presentationA 50-year-old Japanese morbidly obese female was treated with enalapril for 10 years, with no history of angioedema. After 3 h of completion of breast cancer resection under general anesthesia with tracheal intubation, she developed airway obstruction and respiratory arrest. Her oral cavity was occupied with a swollen tongue. It was extremely difficult to determine the airway anatomical orientation although tracheal intubation was attempted using a videolaryngoscope. At this time, she probably started gasping respiration, which generated a faint bubble and revealed a possible airway. Her airway was established using a tracheal tube without confirming the glottis or the vocal cord.ConclusionsAngioedema induced by angiotensin-converting enzyme (ACE) inhibitors is rare; however, once it occurs, it can be potentially life threatening, especially for patients with possible difficult airway. Considering the risk-benefit ratio, we must be careful in administering ACE inhibitor therapy in morbidly obese patients.