Laryngospasm & Bronchospasm Quiz

Laryngospasm & Bronchospasm

• Laryngospasm is a common airway obstruction, often considered a separate entity by anesthesiologists.
• Risk is higher in certain groups: children with asthma or airway infections; those undergoing oesophagoscopy or hypospadias repair; and adults undergoing anal surgery.
• Laryngospasm can be easily recognized but poorly managed cases can cause morbidity and mortality.
• Atypical presentation is possible, potentially increasing harm and further complications (e.g., pulmonary aspiration, pulmonary edema).
• Risk factors include difficult intubation, nasal, oral, or pharyngeal surgical sites, and obesity with obstructive sleep apnea.

Signs of Laryngospasm

• Respiratory signs: inspiratory stridor, increased inspiratory efforts (tracheal tug), paradoxical chest/abdominal movements.
• Cardiovascular signs: desaturation, bradycardia, central cyanosis.
• Airway obstruction.

Precipitating Causes of Laryngospasm

• Airway Manipulation
• Blood/secretions in the pharynx
• Regurgitation/vomiting
• Surgical stimulus
• Moving patient
• Irritant volatile agents
• Failure of anesthetic delivery system
• Inability to determine cause

Management of Laryngospasm

• Initial Management: 100% oxygen, cease all stimulation, remove airway devices, apply gentle CPAP with jaw thrust.
• If spasm persists and desaturation continues: call for help, communicate problem, delegate, deepen anaesthesia , give suxamethonium and continue CPAP, intubate if SpO2 does not improve.
• Consider atropine (10-20mcg/kg) if bradycardia is present.
• Important Note: This is a sequence; time does not allow strict checklist approach.

Laryngospasm Notes

• 77% of cases are clinically obvious. 14% show as airway obstruction; 5% with regurgitation; 4% with desaturation.
• Cricothyroid muscle is the only vocal cord tensor. Gentle jaw thrust and pressure on the mandible.
• Try 20% of induction dose for possible resolution.
• Suxamethonium for severe laryngospasm associated with post-obstructive pulmonary edema, possible without intubation. (Dosage: 0.5mg/kg IV, 1.0-1.5mg/kg IV for intubation, 4.0mg/kg IM for intubation if no IV access).
• Atropine (0.01mg/kg) for possible bradycardia.

Bronchospasm

• Manifests as expiratory wheeze during anesthesia.
• Expiration is prolonged, and pressures increase during IPPV (intermittent positive pressure ventilation).
• Presence or absence of audible wheeze can be confirmed by auscultation; requires gas flow for detection.

Causes of Bronchospasm

• Induction: airway irritation, anaphylaxis, endotracheal tube misplacement, aspiration of gastric contents, pulmonary edema (from failed intubation).
• Maintenance: Anaphylaxis, endotracheal tube or ventilator problems, aspiration, laryngeal mask, mask anesthesia.
• Emergence/Recovery: pulmonary edema, anaphylaxis, accidental extubation, exubation spasm, aspiration, unilateral bronchospasm and pulmonary edema (cause undetermined).

Bronchospasm Management

• Identify the cause.
• Assessment: Check for anaphylaxis; inspect airway for manipulation, irritation, secretions, or soiling.
• Interventions:
• Consider esophageal or endobronchial intubation, as well as bronchodilators, chest x-ray, and admission to ICU.
• Administer salbutamol (0.5% 1mL, 5mg solution nebulized for adult) (2 puffs, 0.1 mg/puff).
• Adrenaline (0.001 mg/kg bolus). Repeat bolus or administer intravenous infusion (0.00015mg/kg/min).

Emergency Management

• Administer 100% oxygen
• Stop stimulation (of the patient).
• Stop surgical procedure.
• Deepen anesthetic.
• If intubated, exclude esophageal or endobronchial position.
• Consider laryngospasm, regurgitation, aspiration, for mask or laryngeal mask use.
• Possible interventions to include consider the placement , kinking, obstruction or circuit, pneumothorax, aspiration, anaphylaxis or pulmonary edema if ventilation via endotracheal tube is difficult.
• Consider obstruction distal to endotracheal tube; reposition the tube. If one bronchus is ventilated, reposition to aid the ventilation of the other.

Test your knowledge on laryngospasm and bronchospasm, two critical airway management issues in anesthesia. This quiz will cover risk factors, signs, and causes associated with these conditions. Understand their implications in various surgical contexts and improve your preparedness for real-life scenarios.