laryngospasmi

Laryngospasm is a sudden, involuntary spasm of the laryngeal muscles that narrows or closes the glottic aperture, causing partial or complete airway obstruction and impaired ventilation. It is most commonly described in the context of anesthesia, particularly during induction or emergence when airway irritation or inadequate anesthesia depth is present, but it can occur in awake individuals as well.

Causes and risk factors include airway instrumentation, secretions or blood in the airway, laryngeal irritation from irritants or reflux, upper respiratory infection, and electrolyte or metabolic disturbances. It is more frequent in children, and in individuals with reactive airways or airway abnormalities. Triggers during anesthesia may include inadequate depth of anesthesia, stimulation from suctioning, intubation, or extubation.

Clinical features consist of sudden onset coughing or a choking sensation, inspiratory stridor or high-pitched noise, accessory muscle use, hypoxemia, and sometimes silent chest with absent air entry if complete obstruction occurs. The diagnosis is clinical, based on observation of laryngeal closure and respiratory compromise, with exclusion of other causes of acute respiratory obstruction.

Management requires immediate action to secure and optimize the airway. Steps include calling for help, removing airway irritants if possible, administering 100% oxygen, and providing gentle positive pressure ventilation. In the anesthesia setting, fast-acting pharmacologic relaxation of the laryngeal muscles may be necessary, commonly with a small dose of propofol or a neuromuscular blocker as guided by the clinical situation. Suctioning and treatment of concomitant bronchospasm or secretions may be required.

Prevention strategies focus on adequate airway anesthesia and depth, gentle extubation, thorough airway suctioning, and avoiding airway irritants when possible. With prompt treatment, most episodes resolve without lasting sequelae, though severe hypoxia can cause complications.