Laryngospasm: The Silent Menace
Laryngospasm may occur during induction or emergence from general anesthesia, or following irritation of the upper airway from any cause in semiconscious patients. There is no reliable prevention, so treatment is the only recourse. The consequences of ine
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Laryngospasm: The Silent Menace
Introduction Laryngospasm is defined as the involuntary spasm or contraction of the muscles of the larynx resulting in total occlusion of the airway. It occurs most commonly during emergence from general anesthesia, usually immediately after removal of a tracheal tube, laryngeal mask airway, or other airway device. Rarely, it may also occur in unanaesthetized subjects should they be at risk for pulmonary aspiration from, for example, gastroesophageal reflux disease. The reason that “silent” is in the title of this chapter is because laryngospasm does not create any sound. Laryngeal stridor is accompanied by a high-pitched, striderous sound of varying intensity as gas transgresses the glottic opening. In contrast, laryngospasm is totally noiseless because no gas passes the tightly closed glottis. The deceiving part is that the chest appears to be moving in a regular manner, suggesting ventilation. However, the experienced eye immediately recognizes that the pattern of movement of the chest is quite abnormal. Instead of rising normally with inhalation, the upper chest and suprasternal neck collapse inward in response to the negative intrathoracic pressure generated by the inspiratory effort. At the same time, the lower chest and abdomen may move downward and outward, again suggesting that ventilation is occurring, which it is not. Signs of Laryngospasm • Absence of ventilatory sounds • Inward movement of upper chest with inhalation • Downward, outward movement of lower chest and abdomen with inhalation • Inability to ventilate the lungs with bag-mask
Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3319-42866-6_5) contains supplementary material, which is available to authorized users. Videos can also be accessed at http://link.springer.com/chapter/10.1007/978-3-319-42866-6_5. © Springer International Publishing Switzerland 2017 C.P. Larson Jr., R.A. Jaffe, Practical Anesthetic Management, DOI 10.1007/978-3-319-42866-6_5
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5 Laryngospasm: The Silent Menace
• Deteriorating oxygen saturation despite oxygen administration by mask • Presence of pink-tinged fluid in the oropharynx
Although the Chest and Abdomen are Moving, There are No Breath Sounds When Laryngospasm is Present The reason that the word “menace” is used in the title of this chapter is because laryngospasm can cause serious complications and even death. Three actual cases are cited as examples of what can happen when laryngospasm is not promptly diagnosed and treated.
Case 1 A 22 year old, otherwise healthy man was admitted to hospital for removal of nasal polyps under general anesthesia. After placement of standard monitors, anesthesia was induced with fentanyl, propofol, and succinylcholine, and an endotracheal tube was inserted. Anesthesia was maintained with sevoflurane–oxygen. At the conclusion of the 55-min operation, spontaneous ventilation was established and the sevoflurane was discontinued. Soon thereafter, he responded to commands to take a deep breath and the endo
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