Angiotensin-converting enzyme inhibitor–mediated angioedema is the most common cause of angioedema and accounts for one-third of emergency department visits for angioedema. Nonpitting edema of the face, lips, tongue, and supraglottic/glottic structures may be present, with 9.5 to 15% of patients requiring emergency airway management.1,2  When respiratory difficulties are present, mortality rate is 11%. Angiotensin-converting enzyme inhibitor–mediated angioedema can be unprovoked or triggered by trauma, including dental and head and neck procedures, by endotracheal intubation, or after a mildly traumatic laryngeal mask airway insertion for a short procedure (presenting in our case as slurred speech and tongue swelling [panel A] 5 h after laryngeal mask airway removal). Local accumulation of bradykinin attributable in part to inhibition of degradation by angiotensin-converting enzyme (panel B) leads to tissue swelling. Unlike allergy-histamine-mediated angioedema,...

You do not currently have access to this content.