Understanding Anesthesiology - The Global Regional Anesthesia ...

Laryngospasm
Laryngospasm is the reflexive closure of the glottis.
Laryngospasm is the airway’s response to irritation. It can occur immediately after extubation,
leading to total airway obstruction, particularly in children and young adults.
Extubating the patient at a deep plane of inhalational anesthesia, when the reflex is blunted,
is one way to reduce the risk of laryngospasm but is an approach that is only safely applied
to the pediatric patient.
In adults (and pediatric patients), performing extubation when the patient is wide awake,
(such that consciousness abolishes the reflex), will decrease the risk of post-extubation laryngospasm.
Performing extubation when the patient is at a light plane of anesthesia (not
awake, but not “asleep” either) is generally thought to increase the risk of post-extubation
laryngospasm.
Laryngospasm is more likely to occur in patients with inadequate reversal of muscle relaxation.
It is more common in smokers. Laryngospasm may be an indication of aspiration.
Treatment of laryngospasm must be individualized to the patient according to the presumed
underlying cause and the severity of obstruction. Suctioning the airway clear of mucous or
other irritants is important. Ensuring full reversal of muscle relaxation is also key. Simple maneuvers
such as airway support and gentle positive pressure ventilation will often “break”
the spasm. Very occasionally, administration of anesthetic agents (possibly including a very
small dose of muscle relaxant) will be required to relieve the airway obstruction.
It is important that the anesthesiologist remain alert to the airway after extubation to recognize
laryngospasm (which can be silent when obstruction is complete) so that deep levels of
hypoxia are not reached.
Related Glossary Terms
Airway obstruction, Aspiration, Extubation, Hypoxemia, Laryngeal mask airway (LMA), Larynx,
Non-depolarizing muscle relaxants, Peripheral nerve stimulator, Residual block
Index
Find Term
Chapter 1 - Airway Management
Chapter 1 - Airway Management
Chapter 1 - Airway Management
Chapter 3 - General Anesthesia
Chapter 3 - General Anesthesia
Chapter 5 - Pediatric Anesthesia
Chapter 6 - Induction Agents
Chapter 6 - Inhaled Agents
Chapter 6 - Inhaled Agents