C.10. How would you manage the patient with laryngospasm?
Answer:
Laryngospasm can be partial or complete. Partial laryngospasm can be diagnosed by a characteristic stridulous noise and a mismatch between respiratory effort and the small movements of the reservoir bag.
Methods of overcoming laryngospasm include applying continuous positive pressure to the airway with 100% inspired oxygen, deepening the level of anesthesia, and administering neuromuscular blockers or a bolus of propofol. A bolus of propofol works quickly, without the side effects of succinylcholine, by increasing the depth of anesthesia or a direct effect on the glottis.
When there is complete laryngospasm, there is no air movement or breath sounds. The application of positive pressure might not be helpful in this circumstance and indeed could make the situation worse by forcing the false cords against the tightly closed true cords. It is much better to relax the cords before hypoxemia becomes severe. A small dose of succinylcholine can be given intramuscularly or intravenously to relax laryngospasm.
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