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Crisis management during anaesthesia: laryngospasm
T Visvanathan1, M T Kluger, R K Webb
1Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Quality & Safety in Health Care
|June 4, 2005
Summary
A structured algorithm can improve the recognition and management of laryngospasm during anesthesia. This approach, when applied to reported incidents, could have enhanced care in 16% of cases, reducing potential harm.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Airway Management
Background:
- Laryngospasm, a potentially life-threatening complication during anesthesia, can present atypically.
- Poorly managed laryngospasm can lead to severe hypoxemia, pulmonary aspiration, and post-obstructive pulmonary edema.
Purpose of the Study:
- To evaluate a structured algorithm, "COVER ABCD-A SWIFT CHECK," combined with a specific laryngospasm sub-algorithm.
- To assess the algorithm's effectiveness in managing laryngospasm associated with anesthesia.
Main Methods:
- Analysis of 189 laryngospasm incidents from the first 4000 reports to the Australian Incident Monitoring Study (AIMS).
- Comparison of the proposed structured approach with the actual management reported by anesthesiologists.
Main Results:
- Laryngospasm presented atypically in 23% of cases (airway obstruction, regurgitation, vomiting, desaturation).
- Common precipitating factors included direct airway stimulation and anesthetic delivery failure.
- Significant complications observed: desaturation (>60%), bradycardia (6%), pulmonary edema (4%), and aspiration (3%).
Conclusions:
- Laryngospasm requires prompt and effective management due to its potential for atypical presentations and severe outcomes.
- A structured approach, including the "COVER ABCD-A SWIFT CHECK" algorithm and a laryngospasm sub-algorithm, is recommended.
- This structured approach could have improved recognition and/or management in 16% of analyzed laryngospasm incidents.