ABSTRACT : Introduction Negative pressure pulmonary edema is a well recognized phenomenon among the anesthesiologists. We report the case of a 65 years old female who underwent thyroidectomy developed acute airway obstruction approximately ten minutes after extubation. Vigorous inspiratory efforts against a completely obstructed airway, led to the development of acute negative pressure pulmonary edema.

METHODS : Case Report A 65 years old female presented with a three year long history of thyroid swelling underwent thyroidectomy and her intra operative course was uneventful. Approximately ten minutes after extubation, the airway became obstructed. The trachea was reintubated, following that pink froth was noted coming out of the endotracheal tube . After three days of ventilation her pulmonary edema resolved. As there was no evidence of airway obstruction while breathing spontaneously following rigid bronchoscopy, it was decided to extubate the trachea. She again became increasingly dyspnoeic with marked tracheal tug and intercostalsindrawing. The trachea was reintubated and mechanical ventilation resumed. Finally, the trachea could be extubated after four days. The rest of her postoperative course was uneventful.

RESULTS : Discussion Tracheomalacia is an important clinical problem complicating long standing goitre. The mechanism for NPPE involves an alteration in pulmonary microvascular pressure together with an increase in pulmonary capillary permeability.

CONCLUSIONS : Conclusion It produces a clinical picture hardly distinguishable from other various conditions. There were no findings in our patient\'s history, or on the preoperative examination, suggesting the development of respiratory difficulties during anesthesia. So tests for detecting the tracheomalacia should always be done before extubating following thyroidectomy cases.