Angiotensin-converting Enzyme Inhibitor–mediated Angioedema

Angiotensin-converting enzyme inhibitor–mediated angioedema is the most common cause of and accounts for one-third emergency department visits angioedema. Nonpitting edema face, lips, tongue, supraglottic/glottic structures may be present, with 9.5 to 15% patients requiring airway management.1,2 When respiratory difficulties are mortality rate 11%.3 can unprovoked or triggered by trauma, including dental head neck procedures, endotracheal intubation,3 after a mildly traumatic laryngeal mask insertion short procedure (presenting in our case as slurred speech tongue swelling [panel A] 5 h removal). Local accumulation bradykinin attributable part inhibition degradation angiotensin-converting (panel B) leads tissue swelling. Unlike allergy-histamine-mediated angioedema, not associated pruritis, rash, hypotension, bronchospasm. As such, antihistamines, steroids, epinephrine unlikely effective. Plasma transfusion, C1-inhibitor replacement protein, antifibrinolytics, icatibant, selective β2-receptor antagonist, have shown promising efficacy. risk factors include ethnicity (people African descent Hispanics higher incidence than Caucasians), women, smoking, elderly, history drug seasonal allergies, use immunosuppressants. Recurrence rates high increasing severity, thus inhibitor must discontinued. Attacks self-limiting, lasting 48 72 h.When distress present/imminent, orotracheal intubation difficult because A). Preparation front-of-neck airway, marking cricothyroid membrane C) calling otolaryngologic support, should made while an nasotracheal carried out. In case, epiglottis larynx were swollen.The authors acknowledge Emily Cook, M.D., Joanna Dion, F.R.C.P.C., Department Anesthesiology Perioperative Medicine, Jason A. Beyea, Ph.D., F.R.C.S.C., Division Otolaryngology-Head Neck Surgery, Queen’s University, Kingston, Ontario, Canada, their assistance figure patient care.The declare no competing interests.