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ORIGINAL ARTICLE |
1 Staff Specialist, Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
2 Senior Staff Specialist, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
3 Senior Staff Specialist; Department of Anaesthesia and Intensive Care, The Townsville Hospital, Douglas, Queensland, Australia
4 Deputy Director, Department of Paediatric Anaesthesia and Pain Management, Royal Children’s Hospital, Parkville, Victoria, Australia
Correspondence to:
Professor W B Runciman
President, Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia 5001, Australia; research{at}apsf.net.au
Background: Laryngospasm is usually easily detected and managed, but may present atypically and/or be precipitated by factors which are not immediately recognised. If poorly managed, it has the potential to cause morbidity and mortality such as severe hypoxaemia, pulmonary aspiration, and post-obstructive pulmonary oedema.
Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for laryngospasm, in the management of laryngospasm occurring in association with anaesthesia.
Methods: The potential performance of this structured approach for the relevant incidents amongst the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.
Results: There were 189 reports of laryngospasm among the first 4000 incidents reported to AIMS. These were extracted and analysed. In 77% of cases laryngospasm was clinically obvious, but 14% presented as airway obstruction, 5% as regurgitation or vomiting, and 4% as desaturation. Most were precipitated by direct airway stimulation (airway manipulation, regurgitation, vomiting, or blood or secretions in the pharynx), but patient movement, surgical stimulus, irritant volatile agents, and failure to deliver the anaesthetic were also precipitating factors. Desaturation occurred in over 60% of cases, bradycardia in 6% (23% in patients aged <1 year), pulmonary oedema in 4%, and pulmonary aspiration in 3%. It was considered that, correctly applied, the combined core algorithm and sub-algorithm recommended for the diagnosis and management of laryngospasm would have led to earlier recognition of the problem and/or better management in 16% of cases.
Conclusion: Laryngospasm may present atypically and, if not promptly managed effectively, may lead to morbidity and mortality. Although usually promptly recognised and appropriately managed, the use of a structured approach is recommended. If such an approach had been used in the 189 reported incidents, earlier recognition and/or better management may have occurred in 16% of cases.
Keywords: laryngospasm; anaesthesia complications; crisis management; airway obstruction; pulmonary aspiration; pulmonary oedema; desaturation; hypoxia
Related Article
Qual. Saf. Health Care 2005 14: 156-163.
This article has been cited by other articles:
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  W B Runciman, M T Kluger, R W Morris, A D Paix, L M Watterson, and R K Webb Crisis management during anaesthesia: the development of an anaesthetic crisis management manual Qual. Saf. Health Care, June 1, 2005; 14(3): e1 - e1. [Abstract] [Full Text] [PDF]
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T Visvanathan, M T Kluger, R K Webb, and R N Westhorpe Crisis management during anaesthesia: obstruction of the natural airway Qual. Saf. Health Care, June 1, 2005; 14(3): e2 - e2. [Abstract] [Full Text] [PDF]
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S M Szekely, W B Runciman, R K Webb, and G L Ludbrook Crisis management during anaesthesia: desaturation Qual. Saf. Health Care, June 1, 2005; 14(3): e6 - e6. [Abstract] [Full Text] [PDF]
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