Laryngospasm-GA-Exam 2

Question 1

Muscle that tenses:

Answer 1

CricoThyroid
“Cords Tense”

Question 2

Muscle that relaxes

Answer 2

ThyroaRytenoid
“They Relax”

Question 3

Muscle that ABducts:

Answer 3

Posterior CricoArytenoid
“Pull Cords Apart”

Question 4

Muscle that ADDucts

Answer 4

Lateral CricoArytenoid
“Let’s Close Airway”

Question 5

Intrinsic muscles involved in laryngospasm include (3 items)

Answer 5

Cricoarytenoid ** NOT Cricothyroid
Lateral Cricoarytenoid
Thyroarytenoid

Question 6

All muscles involved in the closure of airway during laryngospasm are supplied by which nerve?

Answer 6

RLN

Question 7

Sensory input leading to laryngospasm is from which nerve?

Answer 7

INTERNAL branch of SLN

Question 8

Efferent output leading to a laryngospasm comes from which nerve/s?

Answer 8

EXTERNAL branch of SLN and the RLN

Question 9

Causes of laryngospasm:

Answer 9

• light anesthesia + stim
• airway manipulation
• noxious stim (water, blood, incision, mucus, suctioning)
  -larynx stim with poor depth
  -aspiration/ regurg

Question 10

S/S of laryngospasm:

Answer 10

• INSP. stridor
• increased WOB
  -tracheal tug
• paradoxical respiratory effort “rocking boat motion”
• O2 desat

Question 11

Laryngospasm patho step 1:

Answer 11

Glottis shutter close
-INTRINSIC laryngeal muscles cause VC ADDUCTION and PARTIAL air obstruction

Question 12

Laryngospasm pathology step 2:

Answer 12

Ball Valve Closure
-EXTRINSIC laryngeal muscles contract FALSE VC and SUPRAGLOTTIC SOFT TISSUE, COMPLETE airway closure

Question 13

Solution: -step 1

Answer 13

Stop offending stim/surg

Question 14

Laryngospasm Solution: step 2

Answer 14

100% O2

Question 15

Laryngospasm Solution step 3:

Answer 15

open airway (chin lift/jaw thrust) THEN REASSES AIRWAY

Question 16

Solution step 4:

Answer 16

deepen anesthetic (propofol, etc)

Question 17

Solution step 5:

Answer 17

+ pressure mask ventilation

Question 18

Solution when mask ventilation isn’t possible during a severe laryngospasm:

Answer 18

succinylcholine (0.2-0.5mg/kg IV or 4-5mg/kg IM)

Question 19

Solution when pt is bradycardic with laryngospasm:

Answer 19

atropine

Question 20

Solution when condition does not improve with other remedies:

Answer 20

intubate

Question 21

Other causes of stridor that are NOT laryngospasm:

Answer 21

-anatomic/acquired malformations
-infection (epiglottitis, tonsillitis, croup)
-neoplasms (larynx, trachea, esoph)
-neuro issues (Myasthenia gravis)
-trauma
-allergic reaction

Question 22

Prevention:

Answer 22

anesthetic technique
-recognize pts at risk prior/ensure adequate depth
-avoid extubation/ LMA removal in excitation phase