WorksheetsJUNE 2020: Laryngospasm v.s. Bronchospasm: Tysmans
Total questions: 10
Worksheet time: 10mins
1.) A 10 mos old boy was taken to the operating room for “E” I and D of right hand. History reveals exposure to a father who is a smoker. General Anesthesia was induced by Dr Eheng under direct supervision of Dr Cruz. Two minutes after loss of eyelash reflex a inspiratory stridor with suprasternal retraction occurred. What is your diagnosis?
Complete Laryngospasm
Partial Bronchospasm
Bronchospasm
Partial Obstruction of tracheal tube
With your diagnosis above… how do you succinctly define it?
Glottic closure due to reflex constriction of the laryngeal muscle.
Glottic spasm as different from true complete laryngospasm.
Both vocal cords are firmly pressed posteriorly against each each other.
Leaves a small lumen open at the anterior commissure which allows minimal ventilation by an anesthetist.
What would be your immediate management?
Call for help
Diagnose whether complete or partial laryngospasm
Give rocuronium
CPAP with FiO2 1
Define Complete laryngospasm?
True Laryngospasm as” complete closure of the larynx caused by external stimulation.
Here the ventricular cords (true vocal cords) are tightly occluded.
The paraglottis (intralaryngeal part of the epiglottis) moves anteriorly.
The arytenoids cartilages both perform a dorsal movement thus effectively sealing the larynx.
The incidence of laryngospasm according to Darryl et al ( Journal in Pediatric Anesthesia ) is. EXCEPT:
It occurs more commonly in adult anesthesia practice compared to pediatrics.
Twice that of adults in older children and three times that of adults in younger children
This correlates to 17 events in 1000 anesthetics in children up to 9 years.
That young age and supervision by less experienced and non-pediatric anesthetists, increases the incidence of laryngospasm.
True about bronchospasm…. EXCEPT.
Bronchospasm during general anesthesia can present in isolation or as a component of a more serious underlying pathology such as anaphylaxis.
Perioperative bronchospasm in patients with reactive airways disease is however relatively uncommon
A shark fin appearance showing a delayed rise in ETCOs is diagnostic of bronchospasm.
The overall incidence of bronchospasm during general anaesthesia is approximately 0.2%.
True about causes of wheeze during general anesthesia… EXCEPT.
Bronchospasm
Partial Obstruction of tracheal tube
Laryngospasm
Tension Pneumothorax
True about causes of Peak Airway pressure during IPPV… EXCEPT
Excessive tidal volume
Large diameter tracheal tube
Bronchospasm
Obesity
True about Bronchospasm occurence during General anesthesia … EXCEPT.
Bronchospasm occurs most commonly and approximately equally during the induction and maintenance stages of anaesthesia.
Less often encountered in the emergence and recovery stages.
Bronchospasm during the induction stage is most commonly caused by airway irritation, often related to extubation.
During the maintenance stage of anaesthesia, bronchospasm may result from an anaphylactic or serious allergic reaction.
When assessing bronchospasm there are other important differential diagnosis and contributing factors to consider: EXCEPT
Mechanical Obstruction
Bronchial Hyperactivity
Pharmacologic
Laryngospasm
