Sevoflurane
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Laryngospasm: case report A 47-year-old man developed laryngospasm following administration of anaesthesia with sevoflurane. The man presented for cystoscopy and transurethral resection of the prostrate. His medical history was significant for morbid obesity. A general endotracheal anaesthesia was planned for him. Preoxygenation was performed with 100% fresh oxygen for 5 minutes prior to induction. He received induction with lidocaine, propofol and suxamethonium chloride [succinylcholine]. Thereafter, he underwent an endotracheal tube insertion. Lidocaine jelly was applied around the oral endotracheal tube to avoid irritation. He received intraoperative maintenance anaesthesia with 1.2 minimum alveolar concentration of sevoflurane [dosage and route not stated] along with oxygen, fresh air and rocuronium bromide [rocuronium]. Additionally, he received prophylactic therapy with dexamethasone, ondansetron, metoclopramide and famotidine for postoperative nausea and vomiting. He also received ketorolac, neostigmine and glycopyrrolate before extubation. Subsequently, he was extubated and he began to respond and converse with the staff. Shortly thereafter, he stopped conversing with the staff and effectively ventilating on his own. His arterial oxygen saturation (SaO2) fell to 80% and 100% oxygen was applied. Based on the inability to ventilate, he was diagnosed with laryngospasm [time to onset not stated]. The man’s treatment was started with suxamethonium chloride. Additionally, he received positive pressure ventilation, jaw thrusts along with a two-handed mask seal, and he was reintubated. Then, his oxygen saturation rose to 94% and he was awake 2 minutes later. Over the following 10 minutes, his muscle strength returned to normal and he was extubated. Subsequently, he was transferred to postanesthesia care unit (PACU) and was monitored for airway obstruction. At that time, his SaO2 was 98% with 6 L/min of oxygen. Three minutes following arrival to PACU, he again experienced laryngospasm and froze in place. A jaw thrust was performed and positive pressure was applied though a big valve mask supplying oxygen. Thereafter, a simple face mask was placed with oxygen at 10 L/min. Eight minutes later, he again froze in place and ceased exhalations; however, SaO2 concentration did not decrease this time as a jaw thrust and positive pressure was applied immediately. Thereafter, it was decided to transfer him to ICU for overnight observations. Oxygen was applied at the rate of 10 L/min via simple mask. Seven minutes following the third laryngospasm, he experienced fourth episode of laryngospasm. He received suxamethonium chloride and then, he was intubated. After resolution of the fourth episode, he was planned to be intubated overnight with sedation and transferred to the ICU. He was discharged on post-operative day 2. Since pungent volatile anaesthetics have a tendency to lead to laryngospasm, his laryngospasm was attributed to sevoflurane. Chambers P. Repeated postanesthetic laryngospasm in a male adult. AANA Journal 88:
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