Thought on Laryngeal Spasm

I knew I was about due to have a pt have a laryngeal spasm, but I had 2 this week. Just wondering if anyone has any tricks they use to avoid them other than suction oral pharynx, no stage 2 extubation. Both cases were middle age adults. One male one female. Both had eyes open, spont. breathing, decent tidal vol, suctioned. Upon extubation the first had the tale-tale noise, the second did not spasm untill about 1 min. post extubation. PPV applied with significant force. Expiratory stridor. I was reaching for the succs as it broke.

Thanks

Many, if not most laryngospasms occur because the patient has a reactive airway and is not quite responsive enough to handle it themselves. The reactive airway may be due to secretions, blood, edema, foreign body, allergy or who knows what else. It is seen more commonly in the young patient.

Knowing when to extubate can be useful in preventing a spasm. In my practice, I usually extubate deep and let the patient slowly respond. Most of you do not have the luxury of not being pressured to have a quick OR turnover and the need to get the next case going. I take as much time as the patient needs to react and have very few laryngospasms. That being said, I have had some scary ones, have had to give succinylcholine (5-10 mg) and have great respect for the situation. It is important to learn how to recognize and treat it early, if it can't be prevented.

Yoga CRNA