Laryngospasm
Background
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Involuntary closure of the vocal cords leading to airway obstruction with folding over of epiglottis
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Delayed treatment can lead to:
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↓O2, ↓HR, negative pressure pulmonary edema, aspiration & cardiac arrest
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Considerations
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Can occur anytime (induction, emergence, maintenance) while in a light plane of anesthesia
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Needs to be recognized and treated rapidly
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Risk factors:
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Airway manipulation
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Vocal cord irritation (blood or mucus etc.)
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Young age (i.e. infants)
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URTI
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OSA
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Altered airway anatomy
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Procedures on the airway (e.g. tonsillectomy)
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Signs & symptoms:
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inspiratory stridor
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Retrosternal/substernal retractions
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Rocking movement with inspiration
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Management
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100% O2 with facemask + CPAP + optimize airway position +/- OPA
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Consider Larson's maneuver (bilateral firm digital pressure on the styloid process behind the posterior ramus of the mandible)
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Deepen anesthesia (i.e. propofol or volatile agent)
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Definitive treatment:
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Succinycholine 0.25-0.5 mg/kg IV
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Atropine 0.02mg/kg IV ready for bradycardia
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BMV until muscle relaxant wears off
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Prevention
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Delay surgery if recent URTI
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Suction!
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Manipulate airway only during deep plane of anesthesia
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Avoid ETT (use LMA instead) for > 1 y/o's
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If intubating using NDMR
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Lidocaine IV prior to extubation
References
Jagannathan, N. (2021, October). Complications of pediatric airway management for anesthesia. UpToDate. Retrieved November 5, 2021.