ABSTRACT
This chapter reviews the incidence, clinical manifestations, treatment and outcome of patients with drug-induced upper airway obstruction. The most serious adverse effect of this class of drug is angioedema leading to airway compromise. The hypothesized mechanism of angiotensin-converting enzyme inhibitor angioedema is the inhibition of bradykinin degradation by the drug, which acts as a kininase II inhibitor, as kininase II is identical to angiotensin-converting enzyme. As oral intubation may be difficult owing to the obstructive effects of the sublingual haematoma, the nasal route is preferred. Spontaneous haemorrhaging into the parapharyngeal and submandibular spaces is a rare complication of anticoagulant therapy. Airway management in a patient with significant oral and head and neck pathology should be a joint decision between anaesthetist and surgeon. The loss of genioglossus muscle activity is associated with a decrease in airway patency and collapse of the pharyngeal airway.
