Laryngospasm Complicating Awake Nasal Intubation in Ludwig's Angina

Area of Science:

• Anesthesiology
• Otolaryngology
• Emergency Medicine

Background:

• Ludwig's angina is a severe, rapidly progressing infection of the floor of the mouth.
• Airway compromise is a significant concern in patients with Ludwig's angina.
• Awake fiberoptic intubation is a common technique for securing the airway in patients with difficult airways.

Purpose of the Study:

• To report a case of laryngospasm during awake fiberoptic intubation in a patient with Ludwig's angina.
• To highlight the potential for airway instability even with minimal laryngeal edema.
• To emphasize the importance of preparing for failed intubation and surgical airway in such cases.

Main Methods:

• Case report of a 64-year-old male with Ludwig's angina.
• Awake fiberoptic intubation attempted despite mild supraglottic edema.
• Use of neuromuscular paralysis to restore ventilation and facilitate intubation.

Main Results:

• The patient experienced laryngospasm during the awake intubation attempt.
• Neuromuscular paralysis successfully reversed the laryngospasm and enabled intubation.
• This occurred despite only mild supraglottic edema, indicating a sensitive airway reflex.

Conclusions:

• Minimal laryngeal inflammation can precipitate dangerous airway reflexes like laryngospasm.
• Clinicians must be prepared for potential failure of awake intubation in patients with head and neck infections.
• Prompt recognition and management, including surgical airway, are vital for patient outcomes.