lisinopril and Airway-Obstruction

Angioedema of the face and neck is a rare but potentially fatal complication of angiotensin-converting enzyme inhibitor (ACEI) use. We retrospectively reviewed five cases of ACEI angioedema seen at our institution over the past 2 1/2 years. Four of the cases occurred with enalapril and one with lisinopril. Onset of symptoms varied from two days to ten months. Importantly, three of the five patients had been receiving medication three months or longer, suggesting clinicians must consider this complication during long-term administration of these agents. Three of the five patients were markedly obese, had a history of previous face and neck surgery, or had been intubated in the past. Thus, we propose that previous manipulation or trauma of the upper airway, perhaps resulting in airway narrowing, may represent a risk factor for upper airway obstruction secondary to ACEI-induced angioedema.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Causality; Dipeptides; Enalapril; Female; Humans; Lisinopril; Male; Middle Aged; Obesity; Retrospective Studies; Time Factors

Topics: Aged; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Humans; Lisinopril; Male

We report a case of angioedema caused by angiotensin-converting enzyme inhibitor and topical lignocaine spray, administered during nasendoscopy. Angioedema induced by angiotensin-converting enzyme inhibitors is a rare but well known entity. Allergy to topical lignocaine has been acknowledged as a rare phenomenon when used for dental surgery and for skin anaesthesia, but it has not previously been reported after topical administration prior to nasendoscopy. In the reported case, our patient was unfortunate enough to be allergic to both lisinopril and lignocaine. The result was life-threatening airway obstruction, and the continued use of lignocaine spray sustained the laryngeal oedema. We advise that patients are asked about any and every allergy--specifically, any previous problems with dental procedures--before administration of local anaesthetic spray to the upper aerodigestive tract.

Topics: Administration, Topical; Aged; Airway Obstruction; Anesthetics, Local; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Humans; Lidocaine; Lisinopril; Male

Inhibitors of angiotensin converting enzyme may rarely cause an angioneurotic oedema of the upper aerodigestive tract. The pathomechanism of this side effect depends on an interaction of the drug with hormones regulating the vascular resistance such as the kallikrein kinin system and the prostaglandin system. Anglo-oedema is characterised by subcutaneous or submucosal swelling, which preferably affects the lips, the soft palate, the tongue and the larynx. Pathomechanisms, differential diagnosis and treatment of ACE-inhibitor induced oedema of the upper aerodigestive tract are described by means of 3 case reports.

Topics: Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Captopril; Deglutition Disorders; Enalapril; Humans; Hypertension; Lisinopril; Male; Middle Aged

During the past years, angioedema occurring in association with angiotensin converting enzyme (ACE) inhibitors is seen more and more often. This is due to the increasing use of these drugs for hypertension and congestive heart failure. If the diagnosis is missed and prescription of the ACE inhibitor is prolonged, recurrent and more severe episodes of angioedema may occur. In case of involvement of the upper airway and respiratory distress, the condition may be life-threatening. We demonstrate three such patients, men of 84, 73 and 63 years old. First of all, the airway should be secured. Administration of epinephrine may be indicated. Further use of ACE inhibitors is contraindicated.

Topics: Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Emergencies; Humans; Lisinopril; Male; Middle Aged

Few drug reactions are more life threatening than the sudden development of edema involving the mucosal and submucosal layers of the upper aerodigestive tract. Drug-induced angioedema is a recognized entity of angiotensin-converting enzyme (ACE) inhibitors, and despite reports in medical journals and drug insert warnings, captopril and enalapril continue to be widely prescribed. As these drugs are efficacious and usually well-tolerated in the treatment of mild forms of hypertension, their popularity is rising. From June 1, 1984 to August 1, 1991, 36 patients with angioedema secondary to ACE inhibitors presented at the Medical College of Virginia Hospitals. Thirty were successfully managed with medical therapy. Two were intubated, 1 had placement of a nasal trumpet, and 3 required tracheostomies. Of extreme importance is the recognition that angioedema resulting from ACE inhibitors is probably not immunoglobulin E (IgE) mediated and that antihistaminics and steroids may not alleviate the airway obstruction. The otolaryngologist must be prepared for the need of possible early surgical intervention.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Dexamethasone; Dipeptides; Diphenhydramine; Enalapril; Epinephrine; Female; Humans; Injections, Intravenous; Laryngeal Edema; Lisinopril; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Prognosis

To report a case of fatal angioedema associated with the use of lisinopril, a long-acting angiotensin-converting enzyme (ACE) inhibitor.. Case reports, review articles, short reports, and pertinent information from the patient's medical record.. Data was collected from contemporary medical journals and reviewed by both authors.. Angioedema associated with ACE inhibitors (captopril and enalapril) is well documented in the literature. With increased prescribing of newer, longer-acting agents, this potentially lethal adverse reaction is of even greater concern. Because angioedema associated with ACE inhibitors is a class-related event, the number of reported cases would be expected to increase with increasing numbers of prescriptions written for these drugs. This report, describing a patient who developed angioedema following therapy with lisinopril, illustrates the severity of this adverse reaction.. A 66-year-old man presented to the emergency room complaining of increased swelling of the back of his throat and difficulty breathing. Despite treatment with epinephrine, antihistamines, and corticosteroids, the patient's condition progressed from that of severe laryngeal edema to total laryngospasm and complete airway obstruction. Emergency measures to intubate the patient were complicated by severe swelling of his neck and oropharynx, forcing the physician to perform a grossly traumatic tracheotomy. The difficulty encountered during intubation deprived the patient of oxygen for a significant amount of time, precipitating cardiopulmonary arrest. The anoxic episode resulted in hypoxic, ischemic encephalopathy and, ultimately, death.. Angioedema is a serious, potentially life-threatening adverse effect associated with the use of ACE inhibitors. Clinicians need to be aware of this effect when prescribing ACE inhibitors to treat hypertension and congestive heart failure, and when assessing patients presenting to the emergency room with complaints of tongue or pharyngeal swelling. Patients should be instructed to report immediately to an emergency room for medical attention if they experience any unexplained shortness of breath or swelling of the throat or tongue.

Topics: Aged; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Dipeptides; Heart Arrest; Humans; Hypertension; Lisinopril; Male