Laryngospasm and noncardiogenic pulmonary edema

The incidence of laryngospasm in the PACU after extubation remains low despite the number of extubations that are performed annually. A study of general anesthesia patients conducted by Olsson and Hallen in 1977 & reported by Holmes et al (Am J Sports Med 19:365-371, 1991) showed the incidence of laryngospasm to be 8.7/1,000 patients. A literature review since 1977 presents a clinical picture of an emergent situation that may be anticipated by nursing staff (Hamlin et al: J Post Anesth Nurs 6:43-49, 1991). Noncardiogenic pulmonary edema (NCPE), also called negative-pressure pulmonary edema (NPPE) (De Franco M: Crit Care Nurse 9:20-22, 1993), and postextubation laryngospasm induced pulmonary edema (LIPE), can be a serious complication of laryngospasm. Its etiology and thus its treatment differs from other forms of noncardiogenic pulmonary edema, such as acute respiratory distress syndrome (ARDS). The PACU nurse must be aware that any patient has the potential for postextubation laryngospasm, and must be prepared to initiate appropriate treatment of noncardiogenic pulmonary edema.