Laryngospasmus

Laryngospasmus, or laryngospasm, is a sudden, involuntary spasm of the laryngeal muscles that causes the vocal cords to adduct and close the glottis, restricting or stopping airflow. It most commonly occurs during anesthesia or emergence from anesthesia, but it can also arise in awake individuals in association with airway irritation, infection, trauma, or gastroesophageal reflux.

The condition presents with rapid onset dyspnea, inspiratory stridor, chest or neck retractions, and, in complete spasm, little or no air movement and potential hypoxemia or cyanosis. Patients may appear distressed and unable to vocalize. Laryngospasm can be self-limited or progress to airway obstruction if not promptly managed.

Causes are varied. In the operating room, triggers include light anesthesia, airway secretions, blood or edema, suctioning, or recent extubation. Outside of anesthesia, laryngospasm can follow laryngeal irritation from infections (such as croup or laryngitis), post-URI airway hyperreactivity, allergic reactions, or GERD.

Diagnosis is clinical, based on the sudden halting of airflow with preserved airway anatomy. Differential diagnoses include airway obstruction from a foreign body, epiglottic disease, or severe bronchospasm; laryngoscopy may be used in selected cases to assess vocal cord movement.

Management prioritizes securing oxygenation and the airway. Steps include elevating the head, applying 100% oxygen, removing stimulating factors, and using positive-pressure ventilation with bag-mask or CPAP if needed. If the spasm persists, administer a rapid-acting muscle relaxant such as suxamethonium (succinylcholine) 0.1–0.5 mg/kg IV to relax the laryngeal muscles, and proceed with airway management as necessary. Treatment also targets underlying causes and may involve bronchodilators or anti-reflux measures. Early recognition improves prognosis.