laryngospasm

  1. saw it for the first time today.....i have seen alot - but that.....i hope to never see that again!

    i am glad i saw it as a student though, before i was off on my own.....

    27y/o female, ENT surg....emerged fine...breathing on own...took ET tube out, left oral in....woke up...took oral out....SPASM....you just never know.
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  2. 17 Comments

  3. by   charles-thor
    Doesn't an oral airway potentially precipitate laryngospasm in lightly anesthetised and near awake patients?
  4. by   ctbsurf
    w/ ENT procedures there is potential for lots of bloody secretions. suctioning is very important. if patient was already spont. vent. but still in no-man's land the oral airway + secretions probably caused the spasm. what did you have to do to break it? was it easy to break?
  5. by   Tenesma
    no - in fact, oral airways can increase the risk of laryngospasm...
  6. by   ctbsurf
    i think we are all in agreement w/ the oral airway linkage
  7. by   athomas91
    the CRNA i was w/ used the oral airway because she was just still a little groggy but spon. ventilating herself... she was thoroughly suctioned...she woke up, opened her eyes and....kaboom...

    we gave 20mg sux...reinserted oral airway, bagged and ventilated until she was wide awake and breathing again.....
  8. by   gwenith
    Seen quite a bit of post tube laryngospasm myself - working in ICU - we use nebulised adrenaline if it does not settle.
  9. by   Tenesma
    nebulised epinephrine and laryngospasm have nothing to do with each other...
  10. by   Oldsalt
    I have found that over time - you will be able to descrene the slight clues precipitation a spasm -

    I tend to be of opinion for exceelent suctioning, deep extubation (if no contraindications), and laryngeal blunting meidcations (LTA, IV lido, generous narcotics w/o hampering ventilation or emergence)

    But the most important techinques - is to be prepared, stay calm, deal with it expediously, and move on.

    Good luck and enjoy your studies!
  11. by   Brenna's Dad
    Speaking of Racemic epi, can anyone explain why the racemic form is used?? Apparently, the S-isomer has little to none pharmacological action. One article I read stated that regular Epi at half the concentration of the Racemic is equally effective.
  12. by   Tenesma
    1) racemic epi is cheaper

    2) you guys are missing my point: you don't use epinephrine for laryngospasm after extubation!!! it is useless... the only time epinephrine is relevant is when the laryngospasm/stridor is due to vocal cord edema (due to manipulation or allergic reaction)...

    3) the treatment is positive-pressure ventilation until it resolves, and if that doesn't work you either deepen their anesthesia with IV propofol or get rid of the muscle tone with succinylcholine...
    Last edit by Tenesma on Feb 26, '04
  13. by   athomas91
    yep.... we couldn't ppventilate..she had everything clamped TIGHT.....
    the CRNA was exceedingly calm...attempted to ppventilate - assessed it wasn't going to happen - instructed me to give 20mg sux....reinserted oral airway when the spasm relaxed and then ppventilated her until she awoke...

    but it was fast....and scary....





    oldsalt..... the CRNA i work w/ almost always extubates deep....usually it is very smooth!
  14. by   gwenith
    Quote from Tenesma
    1) racemic epi is cheaper

    2) you guys are missing my point: you don't use epinephrine for laryngospasm after extubation!!! it is useless... the only time epinephrine is relevant is when the laryngospasm/stridor is due to vocal cord edema (due to manipulation or allergic reaction)...

    3) the treatment is positive-pressure ventilation until it resolves, and if that doesn't work you either deepen their anesthesia with IV propofol or get rid of the muscle tone with succinylcholine...

    AS I said I work Intensive Care - not post-op and I gave it under direction of an Intensivist. Now we have a different training than you do but an Intensivist here is usually a Medical Officer/Anaesthetist who has done one of THE most intense and difficult periods of training you can imagine. I have seen it used on more than one occasion and by more than one Intensivist.

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