Laryngospasm Flashcards
What is the definition of laryngospasm?
It is the adduction of the vocal cords/glottis while the patient is in the second stage of anaesthesia
Who does laryngospasm affect more?
- Children
What is the pathophysiology of laryngospasm?
It is a primitive reflex caused by cricoartenoid, thyroartenyoid, and cricothyroid to prevent aspiration
What are the causes of laryynfospasm?
It is caused by
- irritating/inhalational gases such as desoflurane and isoflurane
- URTI has a 10 times more risk
- passive smoking
- blood, gastric contents(secretions)
- Nasogastric tube
- LMA’s
- stimulation from surgeon too early
Use neuromuscular blocker and intravenous intubation if you need to do tracheal intubation?
In children
What are the features of incomplete laryngospasm?
- Inspiratory stridor
- tracheal tug
- paradoxical chest movements
- pupils are divergent in second stage of anaesthesia
What are the features of complete laryngospasm?
- No inspiratory or expiratory breath sounds(stridor)
- tracheal tug
- paradoxical chest movements
What is the management of partial laryngospasm?
- Stop the irritant (it can be surgery)
- Give 100% FiO2 with continuous positive partial pressure(CPAP) and jaw thrust
- If that doesn’t work you can deepen the anaesthesia with propofol which works in 75% of cases
What is the management if the patient presents with complete obstruction?
- Give 1-2mg/kg of succinylcholine IVI or 2-4mg/kg IMI
2. Give atropine in children at risk of bradycardia
What are the things you can do to prevent laryngospasm?
- Suction well before extubation
- Avoid anaesthesia if recent URTI
- Avoid Desoflurane and Isoflurane
- Extubate when fully awake or fully asleep and not in second stage
- Do not stimulate patient until they are deep (pupils are central)
