Laryngospasm Flashcards
What are the usual signs & symptoms of Laryngospasm?
- Stridor
- Respiratory distress - tachypnoea, recession, tracheal tug
- In severe laryngospasm - apnoea, inability to ventilate, rapidly progressing desat
What are the risk factors for laryngospasm?
- Light anaesthesia
- Soiling of the larynx with blood, pus, gastric contents
- Surgical stimulation - esp anal stretch & cervical dilatation
- Reactive airway - asthmatics, smokers
- Infants
- Instrumentation of the airway
- Desflurane>Isoflurane>Sevoflurane
Outline an immediate management plan for laryngospasm
- 100% O2
- Stop the stimulation that precipitated the laryngospasm
- Clear the airway
- Jaw thrust
- Suction blood, mucus if visible - don’t insert sucker blind
- If suspect aspiration - move to aspiration drill
- Remove airway devices that may stimulate larynx
- Apply CPAP
- Maintain CPAP and airway support if improving
- If deteriorating - call for help
- Deepen the anaesthesia (Propofol bolus 2-4mL) and continue CPAP
- If ongoing deterioration - Give Suxamethonium 25mg (adult), 0.1-1mg/kg in children (may need Atropine for associated bradycardia 10-20mcg/kg)
- Intubate if no improvement in SpO2
- May need surgical airway
Is deepening the anaesthetic an option in children?
It is, but needs to be applied with caution
Children can often rapidly desaturate, precluding the option of deepening anaesthesia
Suxamethonium is probably a better option
How else (other than IV) can Suxamethonium be given?
IM, IO or intralingual
Dose is 2-4mg/kg
What sequelae may develop as a result of laryngospasm
Stomach insufflation can increase risk of aspiration or repeat episode (consider passing NGT)
Negative pressure pulmonary oedema (monitor closely in recovery)
Is a Guedel’s a useful adjunct in Laryngospasm?
It can be beneficial and help with provision of CPAP
Use with caution, as an overlarge Guedel may stimulate larynx
