laryngospasm

[athomas91]

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.

[gwenith, BSN, RN]

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.

[Tenesma]

gwenith - don't take this personally... i understand your background, and i just want to guide you...

I am an Intensivist as well as an anesthesiologist, so i am flattered that you feel my training is difficult.. :)

so the laryngospasm you are treating in the unit is VERY, VERY different from the laryngospasm you see in the OR... in the unit, laryngospasm is usually due to swelling of the cords due to an allergic/infectious reaction or due to surgical manipulation, and the patient is able to maintain their own airway (granted a very tenuous airway), in which situation nebulized epinephrine is the right choice because it will vasoconstrict the epithelium and thus assist in further opening the airway...

the laryngospasm you see in the OR status post extubation is usually a muscular over-reaction/reflex that can be initiated (usually in stage II of sleep) due to irritation from a tube being pulled out, from secretions irritating, sometimes some patients go into laryngospasm from having their hand moved a minute or so after being extubated... in that case nebulized epinephrine won't assist with muscular relaxation (which is the cause for the closed cords) and that is why we use succinylcholine (a muscle relaxant) or propofol (an anesthetic)

[gwenith, BSN, RN]

Thank-you for clearing that up I was a little taken aback by your first post but I am now happy because I as well as others would have learnt something new today.

[manowar88]

very interesting posting...I learned a lot.

[Brenna's Dad]

The Racemic form is really cheaper?? How expensive can regular Epi really be??

[WntrMute2]

The Racemic form is really cheaper?? How expensive can regular Epi really be??

I think I learned that racemic epi is all that is available. It is refered to as that out of convention and to distinguish it from IV/SQ epi. There are lots of racemic drugs out there, ketamine for instance.