Management of Laryngospasm.

    

Laryngospasm is the most common cause of post-extubation upper airway obstruction.This may present as mild inspiratory stridor or complete airway obstruction. It is more common in children undergoing upper airway surgery. Laryngospasm is most frequently caused by local irritation by blood or saliva and is likely to occur in patients during light planes of anaesthesia, when they are neither able to prevent this reflex nor generate an adequate cough. In children, the incidence can be reduced if they are left undisturbed in the lateral recovery position until they wake up.  I.V. magnesium (15 mg kg⁻¹ over 20 min) and lidocaine (1.5 mg kg⁻¹) have been used to prevent laryngospasm. Table describes a management plan for established laryngospasm:

 

Laryngeal oedema is an important cause of UAO in neonates and infants and presents as inspiratory stridor within 6 h of extubation. Supraglottic oedema may displace the epiglottis posteriorly blocking the glottis on inspiration. Retroarytenoidal oedema below the vocal cords limits abduction of the vocal cords on inspiration. Subglottic oedema of 1 mm in neonates can reduce the laryngeal cross-section by 35%. Associated risk factors include a tight fitting tube, trauma at intubation, duration of intubation >1 h, coughing on the tube and change of head and neck position during surgery. It is also common in adults after prolonged translaryngeal intubation in the critically ill. Management includes: warm, humidified, oxygen enriched air mixture;  nebulized epinephrine 1:1000 (0.5 ml kg−1 up to 5 ml); dexamethasone 0.25 mg kg−1followed by 0.1 mg kg−1 six hourly for 24 h;  Heliox (60:40 or 80:20) temporarily stabilizes respiration giving other modalities time for effect; reintubation with a smaller tube in severe cases. Source: ceaccp.oxfordjournals.org Read also:    Extubation Algorithm Difficult Airway Algorithm