Thought on Laryngeal Spasm

jwk · Aug 23, 2005

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

Were the NMB's reversed? Did you check with a nerve stimulator? Could they hold their head up on their own for 5 seconds?

yoga crna · Aug 23, 2005

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

gaspassah · Aug 23, 2005

to add a point. make sure you are applying a good positive pressure vent as you remove the tube, most patients will give a good cough and as long as i have been doing this maneuver i havent had a spasm (in an adult), and as yoga said, extubate deep or all the way awake.

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Athlein1 · Aug 24, 2005

Look at M&M on the section that describes the laryngeal notch - p. 78-9. I worked with two excellent clinicians who showed me how to perform this technique, and I can tell you that it really works when correctly applied. The key is to use enough pressure exerted in an inward/upward fashion. It has rescued me more than once...

air · Aug 24, 2005

just like gaspassah said,

if they are awake, take your time, to turn to pop-off valve completely shut, then give them a "sigh" while you extubate. I have done deep extubations only for kids. We had Egar "daddy of inhalation" take to us about deep extubations but most CRNA's/MDA's are not too willing to try it out.

tommyboyrn · Aug 24, 2005

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

What are the chances of having a patient have a laryngeal spasm post cardiac surgery in the ICU. We recover hearts in the ICU and wean to extubate per a protocol, but have never considered laryngeal spasm a complication to watch out for?

Thanks