290 J Pak Med Assoc Case Report Negative pressure pulmonary oedema: A rare complication following general anaesthesia Zeeshan Waheed, Javaid Ahmed Khan Section of Pulmonary & Critical Care Medicine, Department of Medicine, The Aga Khan University, Hospital, Karachi, Pakistan. Abstract An important cause of pulmonary oedema is Negative Pressure Pulmonary Oedema (NPPE) which characteristically develops soon after extubation from an endo-tracheal intubation. In this case report we identified a case of previously healthy man who was intubated for General Anaesthesia for extraction of impacted molar tooth. Soon after extubation he developed severe respiratory distress. Immediate diagnosis of NPPE secondary to post extubation laryngospasm was made. He was promptly treated with 100 percent oxygen via CPAP (continuous positive airway pressure) mask and within an hour he markedly improved and subsequently became asymptomatic. NPPE is an important cause of morbidity and need for ICU admission in a healthy individual. Keyword: General Anaesthesia, Post-extubation, Negative Pressure Pulmonary Oedema. Introduction Pulmonary oedema is a well-known emergency in medicine which needs early detection and prompt treatment. It is typically characterized by rales, jugular vein distention, frothy pink sputum, dyspnoea, with characteristic chest radiographs findings and progressive hypoxaemia. Pulmonary oedema most commonly occurs due to cardiac insufficiency or heart failure, however the non cardiac cause of pulmonary oedema includes Acute Respiratory Distress Syndrome (ARDS), Neurogenic pulmonary oedema, Pulmonary oedema due to fluid overload /renal failure, Drowning and Transfusion-related pulmonary oedema. 1 One of the important cause of Non- Cardiogenic Pulmonary Oedema is Negative Pressure Pulmonary Oedema which characteristically develops soon after extubation from an endo-tracheal intubation and most likely results from patient's attempt to ventilate while he is obstructed usually due to laryngospasm, and thus generating