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Anesthesiology/operation on shoulder

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Question
hello, on the 20.5.13 i had an operation on my right shoulder for arthroscopic subacromial decompression, on recovery i was told i had swallowed an amount of mucus and this caused some choking and was therefore left in recovery for 2 hours before allowed to return to the ward. on return i was given a chest x-ray which showed evidence of congestive cardiac failure.

how dangerous is this condition..i wasn't informed of it till 20 days after the op ?

Answer
while I cannot tell you why you were not informed of your condition immediately following your recovery, I think I can clarify what happened: this sounds like negative pressure pulmonary edema, or NPPE.

When your upper airway is obstructed--for example, by a plug of mucus--a patient is still inclined to take in a deep breath.  Normally, inhaling is caused by a person creating a negative pressure within the lungs, thereby "sucking in" air from the environment.  But with obstruction, this negative pressure creates an extraordinary amount of pressure around the heart (we call it increased afterload), which essentially backs up the blood flow within the lungs and forces fluid into the lung tissues--that's the pulmonary edema.

I know this is kind of technical, and I try to minimize the jargon, but suffice it to say that the oxygenation can be impaired for many hours even after the obstruction has been removed.  Congestive heart failure is similar, but usually implies pre-existing heart disease.  

NPPE typically resolves within 24-48 hours, but supportive treatment during that period may include hospital admission, supplemental oxygen, or even tracheal intubation/mechanical ventilation.

Anesthesiology

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Arjav Shah, M.D.

Expertise

I have a broad anesthetic experience in my Dallas practice, so I can answer most questions about anesthesia, but defer to other's expertise in chronic pain management

Experience

Board-certified in Anesthesiology and Critical Care Medicine, in practice since 1999. I have been in private practice in Dallas since 2001, and am a strong supporter of physician-only anesthesia.

Education/Credentials
Residency in Surgery and Anesthesiology at University of Texas Medical Branch at Galveston, Fellowship in Critical Care Medicine at Wake Forest University

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