What Is a Throat Spasm?

Laryngeal spasm is also one of the complications of anesthesia and can cause serious consequences if not handled properly. It usually occurs under shallow anesthesia and after tracheal tube extraction, especially common in children with upper airway surgery. For example, the incidence after tonsillectomy is about 20%. It is generally believed that when the depth of anesthesia is too shallow to prevent laryngeal spasm reflexes, secretions or blood stimulation of the vocal cords locally can cause laryngeal spasm. Oropharyngeal airway, direct laryngoscope, tracheal intubation, etc. can be induced by direct stimulation of the throat Laryngeal spasm. Surgical procedures under shallow anesthesia can sometimes cause reflex laryngeal spasm. For patients who are not fully conscious with anesthesia, laryngospasm is most likely to occur after tracheal extubation.

Laryngospasm

Laryngospasm refers to the reflex spasm contraction of the laryngeal muscles, which causes the vocal cords to adduct and the glottis to be partially or completely closed, causing patients to experience varying degrees of dyspnea or even complete airway obstruction.

Overview of laryngospasm

Laryngeal spasm is also one of the complications of anesthesia and can cause serious consequences if not handled properly. It usually occurs under shallow anesthesia and after tracheal tube extraction, especially common in children with upper airway surgery. For example, the incidence after tonsillectomy is about 20%. It is generally believed that when the depth of anesthesia is too shallow to prevent laryngeal spasm reflexes, secretions or blood stimulation of the vocal cords locally can cause laryngeal spasm. Oropharyngeal airway, direct laryngoscope, tracheal intubation, etc. can be induced by direct stimulation of the larynx. Laryngeal spasm. Surgical procedures under shallow anesthesia can sometimes cause reflex laryngeal spasm. For patients who are not fully conscious with anesthesia, laryngospasm is most likely to occur after tracheal extubation.

Causes of laryngospasm

l. Airway operation, phlegm suction under shallow anesthesia, placement of oropharyngeal or nasopharyngeal airways, tracheal intubation or extubation to the throat.

2. Caused by stimulation of blood, secretions or vomiting, reflux gastric contents in the airway.

The ancient teachings are: eat nothing, sleep nothing. Joking during meals can easily cause food and soup to enter the airway by mistake, cause choking, and even cause laryngeal spasm. The patient's glottis can be blocked, neither breathing, no breathing, no speech, and suffocation. At this critical moment, if the Tiantu acupoint can be clicked in time, the laryngospasm can be relieved and the patient can be turned into danger.

The acupoint is located 2 inches below the laryngeal node, just in the center of the dimple above the sternum.

Clinical manifestations of laryngospasm

Mild laryngospasm may show slight inspiratory wheezing, and severe upper respiratory tract obstruction may occur. Although the former is not a fatal attack, improper management can quickly develop into the latter. Complete upper airway obstruction is manifested by the disappearance of inspiratory wheezing. It is particularly important that this "silent" obstruction cannot be mistaken for an improvement in clinical manifestations.

Laryngospasm-management measures

If laryngeal spasm occurs, the following measures can be taken to deal with it:

1. Give pure oxygen inhalation, if necessary, pure oxygen positive pressure ventilation, until the patient is awake and laryngeal spasm disappears;

2. If it is caused by too shallow anesthesia, deepen the anesthesia with intravenous or inhalation anesthetic until laryngeal spasm and other reflexes disappear.

3. If necessary, short-acting muscle relaxants can be given, and endotracheal intubation should be performed if necessary. It is generally believed that SpO2 <85% of patients with laryngeal spasm after extubation need further treatment. In addition, the anticholinergic drug atropine can be used to reduce glandular secretion and reduce oropharyngeal secretion stimulation.

Emergency treatment for laryngospasm

l. Mask inhaled by pressurized pure oxygen.

2. Lifting the lower jaw can relieve mild laryngospasm.

3. Stop all stimulation and surgery immediately.

4. Immediately ask others for assistance.

5. Deeper anesthesia can relieve mild to moderate laryngospasm. The commonly used method is. Intravenous induction dose of 20% or increase inhalation anesthetic concentration.

6. Exposing and removing throat secretions to keep the airway open.

7. For severe laryngospasm, a thick needle with a size of 16 or more can be used to give a ring nail for oxygen or high-frequency ventilation.

8. Severe laryngospasm can also be applied with succinylcholine 1.0-1.5 mg / kg, intravenously or 4.0 mg / kg intramuscularly for tracheal intubation.

Laryngeal spasm precautions

1. Tracheal intubation and surgical procedures should be avoided under shallow anesthesia, and hypoxia and carbon dioxide accumulation should be avoided.

2. It is best to perform the extubation with the patient fully awake.

3. Lidocaine can be used to prevent laryngeal spasm after extubation after tonsillectomy. 1 to 2 minutes before extubation, intravenous injection of 1 to 2 mg / kg can significantly reduce the incidence of cough and laryngospasm in children. But then swallowing must be ensured.

Laryngeal spasm drug application

Prophylactic medications reduce respiratory and cardiovascular stress responses during extubation. Intravenous lidocaine 1-1.5 mg / kg 1-2 minutes before extubation can effectively suppress cough and cardiovascular reactions and prevent the increase of ICP and IOP.

Intravenous injection of remifentanil lug / kg before extubation can significantly inhibit the cardiovascular response during extubation without affecting recovery.

In short, good anesthesia management, smooth anesthesia process, close monitoring, as well as the experience and effective treatment of the anesthesiologist are important measures to reduce complications during the extubation period.