Management of Refractory Laryngospasm

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Airway Management

Background:

• Laryngospasm is a common complication during emergence from general anesthesia.
• Current management strategies include mask ventilation, increased anesthesia depth, or succinylcholine, with reintubation for severe cases.
• Recurrence of laryngospasm during re-emergence necessitates advanced airway management plans.

Purpose of the Study:

• To present the first case of refractory laryngospasm successfully managed with Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).
• To highlight THRIVE as a potential noninvasive alternative for managing difficult emergence from general anesthesia.

Main Methods:

• A patient experiencing refractory laryngospasm during emergence from general anesthesia was treated.
• Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was initiated using a high-flow nasal cannula.
• Continuous positive airway pressure (CPAP) was generated via THRIVE to facilitate ventilation and oxygenation.

Main Results:

• THRIVE successfully managed the refractory laryngospasm.
• The patient's oxygenation and ventilation were adequately maintained without reintubation.
• THRIVE was well-tolerated, offering an alternative to mask CPAP.

Conclusions:

• Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an effective noninvasive technique for refractory laryngospasm during general anesthesia emergence.
• THRIVE provides continuous positive airway pressure (CPAP) and facilitates oxygenation and ventilation.
• This case suggests THRIVE should be considered in the comprehensive management of patients with difficult emergence from anesthesia.