LARYNGOSPASM
Laryngospasm is the reflex adduction of the vocal cords in response to irritation of the airway (e.g. secretions, blood, vomit and laryngoscopy) or in response to noxious stimuli during light anaesthesia.
RISK factors:
Patient factors-
-young patients
-URTI
-hyperreactive airways
Surgical factors-
-airway surgery, supraglottic airway devices
Presents with a crowing inspiratory noise in the case of partial obstruction. There may not be any noise in the case of complete obstruction
Paradoxical breathing, tachypnea, arrhythmias. Hypoxaemia, hypercarbia. REDUCED MOVEMENT OF RESERVOIR BAG
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This is an urgent situation which may lead to desaturation and severe morbidity
I would examine the patient immediately and check the SpO2 and attempt manual ventilation.
If there is normal SpO2 or decreasing SpO2:
-if there is difficulty ventilating the patient due to severe spasm or desaturation, I would
-ask the surgeon to halt the stimulus and increase the FiO2 to 1.0.
-provide CPAP
-deepen the anaesthesia using and IV agent such as propofol 20mg. Alternatively I could increase the concentration of inspired inhalational anaesthetics but given the degree of laryngospasm it may not be sufficient.
-If I am unable to ventilate or improve the saturations due to severe laryngospasm, I will give a small dose of IV suxamethonium 0.1-0.5mg/kg. If severe a full dose may be given and the trachea intubated.
-if normal SpO2:
-deepen anaesthesia
-CPAP
-analgesia
-other manouveres: forcible jaw thrust, pressure on the mandible at Larson’s point (anterior to the mastoid process)
-if no IV: !M sux or into the tongue 3mg/kg
Sunday, November 20, 2011
Saturday, November 5, 2011
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