Intraoperative Laryngospasm and Stridor - Guidelines for Crises in Anaesthesia
❶ Call for help and inform theatre team of problem.
❷ Perform jaw thrust and stop any other stimulation.
❸ Remove airway devices and anything else that may be stimulating or obstructing the airway, e.g. suction catheters, blood or vomit (direct visualisation and suction if in doubt).
• A correctly positioned tracheal tube rules out laryngospasm.
❹ Give CPAP with 100% oxygen and face mask:
• Avoid over-vigorous attempts at lung inflation, as this may inflate the stomach.
• Insert an oro-pharyngeal and/or nasal airway if you are not sure that the airway is clear above the larynx.
❺ If problem persists:
• Continue CPAP.
• Deepen anaesthesia.
• Give a neuromuscular blocker (See Box A).
❻ Consider tracheal intubation particularly if likely to recur.
❼ Use nasogastric tube to decompress the stomach.
❽ Consider other causes (Box B).
❾ Consider whether guideline 2-3 Increased airway pressure may help.
❿ Consider the appropriate strategy, location and support needed for waking the patient.
⓫ Continued airway and ventilation support may be necessary if aspiration has occurred or if the patient has developed negative-pressure pulmonary oedema.
By Association of Anaesthetists @ https://twitter.com/AAGBI
Quick Reference Handbook - Guidelines for crises in anaesthesia
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