Postoperative Stridor

Question 1

What is stridor?

Answer 1

High-pitched sound due to turbulent airflow in the upper airway. Indicates acute upper airway obstruction.

Question 2

What are the clinical features of postoperative stridor?

Answer 2

1. Anxiety
2. Restlessness
3. Hoarseness
4. Respiratory distress - cyanosis
5. Nasal flaring
6. Use of accessory muscles, upright posture

Question 3

What is the differential diagnosis of stridor?

Answer 3

1. Anatomic/acquired malformations
2. Infection
3. Neoplasms
4. Neurologic disorders
5. Trauma
6. Allergic reaction
7. Vascular rings
8. Laryngospasm, asthma

Question 4

What is the management of stridor?

Answer 4

1. Narrow differential diagnosis based on focused H&P
2. Assess need for emergent airway
3. Consider FOB or other imaging to assess pathology
4. If conservative management is reasonable:
   - O2
   - nebulized epinephrine for airway edema
   - dexamethasone 4mg to 8mg IV for airway edema
   - heliox
5. If airway management required, follow difficult airway algorithm
6. In most clinical situation, awake FOB intubation is indicated with surgical airway as backup plan