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Table of Contents
LETTER TO EDITOR
Year : 2014  |  Volume : 30  |  Issue : 2  |  Page : 300-301

Regurgitant food particle causing intractable laryngospasm during emergence from anesthesia


Department of Anesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Web Publication9-Apr-2014

Correspondence Address:
Tim Thomas Joseph
Department of Anaesthesiology, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.130130

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How to cite this article:
Sharma M, Joseph TT, Chaudhuri S, Rao AK. Regurgitant food particle causing intractable laryngospasm during emergence from anesthesia. J Anaesthesiol Clin Pharmacol 2014;30:300-1

How to cite this URL:
Sharma M, Joseph TT, Chaudhuri S, Rao AK. Regurgitant food particle causing intractable laryngospasm during emergence from anesthesia. J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2020 Oct 23];30:300-1. Available from: https://www.joacp.org/text.asp?2014/30/2/300/130130

Sir,

Laryngospasm is a common airway related complication in routine anesthetic practice. It is characterized by persistent spasmodic closure of larynx. [1] Persistent refractory complete laryngospasm during emergence after removal of an airway device is challenging to diagnose and treat. [2] A 58-year-old male weighing 62 kg with no known comorbidities was scheduled for tendon repair of index finger under general anesthesia using ProSeal laryngeal mask airway (PLMA). He was kept fasting for solids 12 h and 3 h for clear liquids. Tab. ranitidine 150 mg and tab. metoclopromide 10 mg was given night before and the day of surgery. Intravenous ramosetron 0.3 mg was given. At the end of procedure, Ryle's tube was suctioned via drain tube and removed noting no obvious gastric contents. At this time partial laryngospasm was noted as patient breathing spontaneously till now suddenly developed noisy breathing and loss of capnography trace. In view of PLMA being a predisposing factor for undesired airway stimulation under lighter plane of anesthesia, it was quickly removed. Patient continued to be assisted with 100% oxygen and gentle CPAP of 20 cm H 2 O. Within 60 s chest was seen expanding again coinciding well with reservoir bag movement and return of capnography trace. However, partial laryngospasm returned with a noisy breathing and progressed to complete laryngospasm. Upper airway obstruction was ruled out as a lubricated nasopharyngeal airway was gently inserted and showed only minimal secretions on suctioning. Once the patient became more awake, he had a sudden bout of vigorous cough and patient coughed out unidentifiable material into the face mask which immediately relieved the spasm. Closer examination revealed it was an unsuspecting food particle (intact skin of a red chilly) which he probably regurgitated and was causing recurrent laryngospasm.

Identifying the possible cause of laryngospasm correctly is challenging. [3] General anesthesia predisposes to gastric regurgitation and aspiration. The use of a supraglottic airway device and spontaneous ventilation dose not completely secure the airway.

The technique of draining the stomach via a Ryle's tube in a PLMA may not clear larger food particles from the stomach. Also a PLMA is associated with variable amount of gastric insufflation. [4] In our case regurgitation may have occurred at the end of procedure, in a lighter plane of anesthesia. Presence of a nasogastric tube in situ itself may act as a stimulant for regurgitation since lower esophageal sphincter remains patent. Laryngospasm was refractory to treatment. Only on return of cough reflex was the patient able to expel the food material which is the likely culprit of recurrent laryngospasm. The likelihood of regurgitation is high even in an adequately fasting patient. Laryngospasm may often be an early feature of pulmonary aspiration. A history of gastroesophageal reflux may indicate more chances of developing laryngospasm under general anesthesia. Thus, in presence of recurrent intractable laryngospasm; the possibility of regurgitant food particles persistently irritating the larynx should be thought of early.

 
  References Top

1.Salem MR, Ramez M, Crystal GJ, Nimmagadda U. Understanding the mechanics of laryngospasm is crucial for proper treatment. Anesthesiology 2012;117:441-2.  Back to cited text no. 1
    
2.Visvanathan T, Kluger MT, Webb RK, Westhorpe RN. Crisis management during anaesthesia: Laryngospasm. Qual Saf Health Care 2005;14:e3.  Back to cited text no. 2
    
3.Baduni N, Sanwal MK, Jain A, Kachru N. Recurrent episodes of intractable laryngospasm followed by laryngeal and pulmonary oedema during dissociative anaesthesiawith intravenous ketamine. Indian J Anaesth 2010;54:364-5.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Zhang X, Chen M, Li Q. The ProSeal Laryngeal Mask Airway is more effective than the LMA-Classic in pediatric anesthesia: A meta-analysis. J Clin Anesth 2012;24:639-46.  Back to cited text no. 4
    




 

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