Laryngospasm | Causes, Clinical features, Complications & Management

Summary

This video from Prod Haps Anesthesia delves into laryngospasm, detailing its definition as a sudden closure of vocal cords due to irritation. It outlines causes such as anesthesia induction and irritants, and highlights clinical features like choking and cyanosis. The video offers practical management tips, including halting procedures, oxygen administration, and techniques like positive pressure ventilation and Larson's point pressure. It also addresses complications like hypoxia and bradycardia, and the importance of monitoring for potential issues during treatment.

Takeaways

• 🗣️ Laryngospasm is a sudden closure of the vocal cords due to irritation or stimulation of the larynx.
• 🔍 Common causes include anesthesia induction, irritants, infections, intubation, and allergic reactions.
• 🚑 Clinical features of laryngospasm include a choking sensation, difficulty breathing, stridor, chest retraction, and cyanosis.
• 😨 Patients may appear anxious, distressed, and struggle to breathe during a laryngospasm.
• ⚠️ Hypoxia, or reduced oxygen intake, is a common complication of laryngospasm due to airway obstruction.
• 💔 Bradycardia and cardiac arrest can occur due to vagal stimulation and reflex responses to hypoxia.
• 🗑️ Aspiration, or inhaling stomach contents, can lead to pneumonia as a complication of laryngospasm.
• 🔧 Airway trauma may result from forceful interventions or inadequate techniques during airway management.
• 💊 Residual neuromuscular blockade from muscle relaxant medications can prolong muscle relaxation and cause breathing difficulties.
• 🛑 Immediate management includes stopping the procedure, administering oxygen, and clearing airways if the patient is adequately oxygenated.
• 👌 Techniques such as positive pressure ventilation, Larson's point pressure, and mild sedation with propofol can help break a laryngospasm.

Q & A

What is laryngospasm?

Laryngospasm is a sudden closure of the vocal cords due to irritation or stimulation of the larynx.

When does laryngospasm typically occur?

Laryngospasm mostly occurs during anesthesia induction, due to irritants, infections, while intubating the patient, or due to allergic reactions.

What are the clinical features of laryngospasm?

During laryngospasm, the vocal cords suddenly close, leading to a choking sensation, difficulty in breathing, stridor (high-pitched breathing sounds), chest retraction, and cyanosis (bluish discoloration of the skin).

Why do patients appear anxious and distressed during laryngospasm?

Patients appear anxious and distressed because they struggle to get air due to the sudden closure of the vocal cords.

What is the primary complication of laryngospasm?

The primary complication of laryngospasm is hypoxia, which is a reduced oxygen intake due to airway obstruction.

How can hypoxia lead to bradycardia and cardiac arrest?

Bradycardia and cardiac arrest can occur due to vagal stimulation reflex responses to hypoxia, medication effects, and the strain of oxygen deficiency on the heart.

What is the risk of aspiration during laryngospasm?

Aspiration is the risk of inhaling stomach contents, which can cause pneumonia.

How can airway trauma occur during laryngospasm management?

Airway trauma can occur due to forceful interventions, inadequate techniques, friction, and pressure during airway management.

What is residual neuromuscular blockade and how does it relate to laryngospasm?

Residual neuromuscular blockade refers to prolonged muscle relaxation caused by muscle relaxant medications, leading to difficulty in breathing and impaired muscle function.

What is the first step in managing laryngospasm if it occurs during a medical procedure?

The first step is to halt the procedure immediately and start giving oxygen to maintain oxygenation.

How can Larson's point pressure help in breaking a laryngospasm?

Applying inward pressure at Larson's point along with a jaw thrust can help break a laryngospasm by stimulating the vagus nerve, which can relax the vocal cord muscles briefly, opening the airway for improved breathing.

What medication can be administered to relax muscles and allow intubation if hypoxia persists?

Succinylcholine can be administered to relax muscles and allow intubation if hypoxia persists.

Why is it important to monitor for bradycardia and cardiac arrest during laryngospasm management?

It is important to monitor for bradycardia and cardiac arrest due to airway manipulation or medication effects, which can cause these conditions.

How can lidocaine be beneficial during intubation in a patient with laryngospasm?

Lidocaine can reduce airway sensitivity during intubation, making the process less likely to trigger or worsen laryngospasm.

What is the chest thrust maneuver and when is it used?

The chest thrust maneuver is a technique used to help subside laryngospasm and is used when other methods have not been effective.

Why is it important to keep the airway clear and monitor for potential pulmonary edema during laryngospasm?

Keeping the airway clear and monitoring for potential pulmonary edema is important because negative pressure pulmonary edema can lead to fluid accumulation in the lungs, causing severe breathing difficulties and reduced oxygen levels.