Repeated Postanesthetic Laryngospasm in a Male Adult.

Laryngospasm is a potential complication after general anesthesia that is universally dreaded because the failure to act swiftly and effectively could be fatal for the patient. This case report involves a morbidly obese male patient who received his first general anesthetic and experienced 4 episodes of laryngospasm within an hour after emergence. Laryngospasm occurs when the vocal cords adduct, closing the glottis, thereby preventing gas exchange in a spontaneously ventilating individual. This patient was able to physically indicate his impending glottic closure, thus warning his caregivers of the imminent airway emergency. He was safely intubated during the fourth episode and admitted to the intensive care unit for monitoring. After 2 days, the patient was extubated and recovered otherwise uneventfully. This case demonstrates the high level of vigilance required during all phases of anesthesia care.

Post-anesthesia tracheal extubation.

Caring for the patient in the post-anesthetic period requires an understanding of the intubation and extubation process. The nurse must be knowledgeable of the numerous tracheal extubation-related complications that can occur. Tracheal extubation is a vulnerable period for the patient; there is risk of aspiration, laryngospasm, a cardiovascular response, or hypoventilation occurring. In this article, the author reviews the more common post-extubation difficulties, risk factors, and treatment modalities. After reviewing extubation criteria and the safe extubation process, the nurse can apply this knowledge to patient care. Although nurses are excellent initiators of tracheal extubation, the procedure is ideally performed by an anesthetist or internist who can treat complications that arise, or re-intubate the patient, if required.

Review of laryngospasm and noncardiogenic pulmonary edema.

Laryngospasm is an emergency situation that requires rapid identification and resolution of the obstructed glottis. Although there is a low incidence of laryngospasm, it is important to remember that any patient has the potential for post-extubation laryngospasm. Nurses must know about the causes, risk factors and treatment for this respiratory emergency. This includes the plan of care and possible medications administered to assist in restoring the patient's airway. Nurses must be able to respond quickly to avoid complications such as noncardiogenic pulmonary edema (NCPE) and respiratory arrest. The triggers, signs and symptoms, and treatment of NCPE are also reviewed. Due to the risk of laryngospasm recurring or NCPE presenting itself, any patient who has had laryngospasm needs close monitoring for two to three hours after the laryngospasm has resolved. It is important for nurses to review the interventions for laryngospasm and NCPE prior to caring for a patient with this respiratory emergency.

The use of touch for a patient experiencing laryngospasm.

This article is based on a course work assignment for the Welsh National Board Certificate Level Module in Operating Department Practice (Recovery Branch). The article uses a critical incident reflective approach to explore the issues of using touch in caring for a patient, experiencing laryngospasm following a general anaesthetic. A literature review will explain the mechanisms of laryngospasm and will discuss the use of different forms of touch. Conclusions and recommendations will be drawn from the issues discussed.

Laryngospasm and noncardiogenic pulmonary edema.

The incidence of laryngospasm in the PACU after extubation remains low despite the number of extubations that are performed annually. A study of general anesthesia patients conducted by Olsson and Hallen in 1977 & reported by Holmes et al (Am J Sports Med 19:365-371, 1991) showed the incidence of laryngospasm to be 8.7/1,000 patients. A literature review since 1977 presents a clinical picture of an emergent situation that may be anticipated by nursing staff (Hamlin et al: J Post Anesth Nurs 6:43-49, 1991). Noncardiogenic pulmonary edema (NCPE), also called negative-pressure pulmonary edema (NPPE) (De Franco M: Crit Care Nurse 9:20-22, 1993), and postextubation laryngospasm induced pulmonary edema (LIPE), can be a serious complication of laryngospasm. Its etiology and thus its treatment differs from other forms of noncardiogenic pulmonary edema, such as acute respiratory distress syndrome (ARDS). The PACU nurse must be aware that any patient has the potential for postextubation laryngospasm, and must be prepared to initiate appropriate treatment of noncardiogenic pulmonary edema.

Care of the arthroscopy patient with noncardiogenic pulmonary edema.

A young athlete is unexpectedly admitted to an orthopaedic unit after routine arthroscopic knee surgery with the following diagnosis: noncardiogenic pulmonary edema related to postextubation laryngospasm. This emergent condition, which may be life-threatening due to rapid changes in intrathoracic, alveolar, and interstitial pressures, requires immediate, aggressive treatment. With proper intervention, laryngospasm-induced noncardiogenic pulmonary edema becomes a self-limiting process, and full recovery may occur within 48 hours of the initial insult to the lungs. This article presents a case study of a patient with this condition, including the initial and subsequent interventions that were provided. The pathophysiologic responses and clinical manifestations of laryngospasm and noncardiogenic pulmonary edema are addressed, followed by a suggested course of treatment.

Laryngospasm-induced pulmonary edema: case report.

Laryngospasm during the emergent phase of anesthesia is a respected complication well known to any PACU nurse. One complication of laryngospasm is noncardiac pulmonary edema (NCPE). NCPE can be a catastrophic complication of anesthesia. A case report is presented to illustrate the signs and symptoms of laryngospasm and NCPE. The physiology of hemoptysis and hypoxemia is reviewed. The mechanism of laryngospasm-induced pulmonary edema is described. The need for PACU nurses to comprehend the pathophysiology and implications of laryngospasm and hypoxemia is paramount when determining proper treatment. PACU nurses should be particularly alert to and aware of this complication.

Practical points in the management of laryngospasm.

Laryngospasm is an emergency situation and must be promptly recognized. Without quick recognition and proper treatment, the patient's airway may occlude, leading to respiratory arrest followed by cardiac arrest. Because laryngospasm is a potential life-threatening postoperative event, the PACU nurse must remain a guardian of the airway.