Laryngospasm and stridor
Laryngospasm usually occurs when a patient is in a light plane of anaesthesia and their airway is stimulated in some way. Stridor is a sign and associated with laryngospasm (although it can have other causes).
START.
1
Call for help
2
Jaw thrust
3
Clear the airway
4
CPAP
5
If problem persists
6
Tracheal intubation
7
Decompress stomach
8
Other causes
9
Persistent
10
Plan waking
11
Ongoing support
Box A DRUG DOSES FOR TREATMENT OF LARYNGOSPASM
0.25–0.5 mg.kg⁻¹ i.v.:
Propofol
Rocuronium
Atracurium
Suxamethonium (also i.m. including tongue 4.0 mg.kg⁻¹)
Box B ALTERNATIVES AND MIMICS
Foreign body
Infection of larynx/upper respiratory tract
Anaphylaxis
Airway tumour
Vocal cord paralysis
Intrinsic laryngeal or tracheal obstruction
Extrinsic laryngeal or tracheal compression
Sub-glottic stenosis
Laryngo/tracheomalacia
Box C CRITICAL CHANGES
Cardiac arrest → 2-1
Hypoxia/desaturation/cyanosis → 2-2
Increased airway pressure → 2-3
Hypotension → 2-4
Bradycardia → 2-6