Laryngospasm

Question 1

What are the usual signs & symptoms of Laryngospasm?

Answer 1

1. Stridor
2. Respiratory distress - tachypnoea, recession, tracheal tug
3. In severe laryngospasm - apnoea, inability to ventilate, rapidly progressing desat

Question 2

What are the risk factors for laryngospasm?

Answer 2

1. Light anaesthesia
2. Soiling of the larynx with blood, pus, gastric contents
3. Surgical stimulation - esp anal stretch & cervical dilatation
4. Reactive airway - asthmatics, smokers
5. Infants
6. Instrumentation of the airway
7. Desflurane>Isoflurane>Sevoflurane

Question 3

Outline an immediate management plan for laryngospasm

Answer 3

1. 100% O2
2. Stop the stimulation that precipitated the laryngospasm
3. 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
4. Apply CPAP
5. Maintain CPAP and airway support if improving
6. If deteriorating - call for help
7. Deepen the anaesthesia (Propofol bolus 2-4mL) and continue CPAP
8. If ongoing deterioration - Give Suxamethonium 25mg (adult), 0.1-1mg/kg in children (may need Atropine for associated bradycardia 10-20mcg/kg)
9. Intubate if no improvement in SpO2
10. May need surgical airway

Question 4

Is deepening the anaesthetic an option in children?

Answer 4

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

Question 5

How else (other than IV) can Suxamethonium be given?

Answer 5

IM, IO or intralingual

Dose is 2-4mg/kg

Question 6

What sequelae may develop as a result of laryngospasm

Answer 6

Stomach insufflation can increase risk of aspiration or repeat episode (consider passing NGT)
Negative pressure pulmonary oedema (monitor closely in recovery)

Question 7

Is a Guedel’s a useful adjunct in Laryngospasm?

Answer 7

It can be beneficial and help with provision of CPAP

Use with caution, as an overlarge Guedel may stimulate larynx