Laringoespasmo

Adriano Bechara de Souza Hobaika; Michele Nacur Lorentz

doi:10.1590/S0034-70942009000400012

Review Article

Laringoespasmo

Laryngospasm

Adriano Bechara de Souza Hobaika; Michele Nacur Lorentz

http://dx.doi.org/10.1590/S0034-70942009000400012 Braz J Anesthesiol, vol.59, n4, p.487-495, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: A manutenção das vias aéreas é de importância fundamental para os anestesiologistas, particularmente durante a indução da anestesia e após a extubação, quando ocorre mais frequentemente o espasmo da laringe ou laringoespasmo. O anestesiologista deve conhecer a fisiologia do funcionamento faríngeo-laríngeo e os fatores de risco para a obstrução das vias aéreas, pois se trata de complicação potencialmente grave que pode ocorrer durante procedimento anestésico-cirúrgico, de etiologia multifatorial e cujas consequências podem ser nefastas. O atraso no diagnóstico ou tratamento e a evolução do quadro podem levar à hipoxemia, edema agudo do pulmão e eventualmente óbito do paciente. Nesse contexto o objetivo deste artigo foi rever as medidas que devem ser tomadas em situação de laringoespasmo, já que oxigenação e ventilação adequadas podem ficar comprometidas em tal situação. CONTEÚDO: Este artigo de revisão apresenta os mecanismos de manutenção das vias aéreas, discutindo seus aspectos mais relevantes e etiologia, fisiopatologia, tratamento e prevenção do laringoespasmo. CONCLUSÕES: Há muitas recomendações na literatura que visam tratar ou prevenir o desenvolvimento do laringoespasmo, mas nenhuma é completamente eficaz. Devido à sua gravidade, é necessário que sejam realizados mais estudos com enfoque nas medidas de prevenção dessa complicação.

Palavras-chave

COMPLICAÇÕES, Laringoespasmo, COMPLICAÇÕES, Laringoespasmo

Abstract

BACKGROUND AND OBJECTIVES: Airways management is fundamental for anesthesiologists, especially during induction of anesthesia and after extubation, when laryngeal spasm is more common. The anesthesiologist should know pharyngeal-laryngeal physiology and the risk factors for airways obstruction, since this is a potentially severe complication with a multifactorial etiology that can develop during anesthesia and whose consequences can be catastrophic. A delay in the diagnosis or treatment and its evolution can lead to hypoxemia, acute pulmonary edema, and, eventually, death of the patient. In this context, the objective of this report was to review the measures that should be taken in cases of laryngospasm because adequate oxygenation and ventilation may be compromised in this situation. CONTENTS: This review article presents the mechanisms of airways management, discussing the most relevant aspects and etiology, pathophysiology, treatment, and prevention of laryngospasm. CONCLUSIONS: The literature has several recommendations on the treatment or prevention of laryngospasm, but none of them is completely effective. Due to its severity, further studies on measures to prevent this complication are necessary.

Keywords

COMPLICATIONS, Laryngospasm, COMPLICATIONS, Laryngospasm

References

Isono S. Developmental changes of pharyngeal airway patency: implications for pediatric anesthesia. Pediatr Anesth. 2006;16:109-122.

von Ungern-Sternberg BS, Habre W. Pediatric anesthesia: potencial risks and their assessment. Pediatr Anesth. 2007;17:206-215.

Ludlow CL. Central nervous system control of the laryngeal muscles in humans. Respir Physiol Neurobiol. 2005;147:205-222.

Koga K, Sata T. Laryngospasm associated with anesthesia: diagnosis and management. J UOEH. 2004;26:75-83.

Roy WL, Lerman J. Laryngospasm in paediatric anaesthesia. Can J Anesth. 1988;35:93-98.

Elwood T, Bailey K. The pediatric patient and upper respiratory infections. Best Pract Res Clin Anaesthesiol. 2005;19:35-46.

Homer JR, Elwoodt T, Peterson D. Risk factors for adverse events in children with colds emerging from anesthesia: a logistic regression. Pediatr Anesth. 2007;17:154-161.

Tait AR. Anesthetic management of the child with an upper respiratory tract infection. Curr Opin Anaesthesiol. 2005;18:603-607.

Nichols DG, Yaster M. Victims of our own success of quo vadis pediatric anesthesia?. Anesth Analg. 2007;104:255-257.

von Ungern-Sternberg BS, Boda K. Laryngeal mask airway is associated with increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. Anesthesiology. 2007;107:714-719.

Baker SB, Worthley LI. The essentials of calcium, magnesium and phosphate metabolism: part II. Disorders. Crit Care Resusc. 2002;4:307-315.

Liu EH, Choy J, Dhara SS. Persistent perioperative laryngospasm in a patient with Parkinson's disease. Can J Anesth. 1998;45:495.

Lim YS, Kennedy NJ. Multiple system atrophy as a cause of upper airway obstruction. Anaesthesia. 2007;62:1179-1182.

Seltzer N, Saade E. Childhood obesity and anesthetic morbidity. Pediatr Anesth. 2007;17:321-326.

Visvanathan T, Kluger MT, Webb RK. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care. 2005;14:e3.

Olsson GL, Hallen B. Laryngospasm during anaesthesia: A computer-aided incidence study in 136,929 patients. Acta Anaesthesiol Scand. 1984;28:567-575.

Vanetti LFA. Anestesia para Oftalmologia. Tratado de Anestesiologia SAESP. 2006:1455-1452.

Lee C, Kwan WF, Tsai SK. A clinical assessment of desflurane anaesthesia and comparison with isoflurane. Can J Anaesth. 1993;40:487-494.

Hsu YW, Pan MH, Huang CJ. Comparison of inhalation induction with 2%, 4%, 6%, and 8% sevoflurane in nitrous oxide for pediatric patients. Acta Anaesthesiol Sin. 2000;38:73-78.

Cohen VG, Krauss B. Recurrent episodes of intractable laryngospasm during dissociative sedation with intramuscular ketamine. Pediatr Emerg Care. 2006;22:247-249.

Craven R. Ketamine. Anaesthesia. 2007;62(^s1):48-53.

Tait AR, Burke C, Voepel-Lewis T. Glycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections. Anesth Analg. 2007;104:265-270.

Hong J, Grecu L. Laryngospasm after autologous blood transfusion. Anesth Analg. 2006;103:200-202.

Subramani K, Paul A. Laryngospasm during subarachnoid block. Br J Anaesth. 2005;94:668-670.

Singh DK, Chopra G, Jindal P. Ascaris lumbricoides: post operative hypoxia. Internet J Anesthesiol. 2006;11(1).

Koc C, Kocaman F, Aygenc E. The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg. 1998;118:880-882.

Zeidan A, Halabi D, Baraka A. Aerosolized lidocaine for relief of extubation laryngospasm. Anesth Analg. 2005;101:1563.

Tsui BC, Wagner A, Cave D. The incidence of laryngospasm with a "no touch" extubation technique after tonsillectomy and adenoidectomy. Anesth Analg. 2004;98:327-329.

Nishino T, Yonezawa T, Honda Y. Modification of laryngospasm in response to changes in PaCO2 and PaO2 in the cat. Anesthesiology. 1981;55:286-91.

Lee J, Kim J, Kim S. Removal of the laryngeal tube in children: anaesthetized compared with awake. Br J Anaesth. 2007;98:802-805.

Lee JR, Kim SD, Kim CS. Minimum alveolar concentration of sevoflurane for laryngeal mask airway removal in anesthetized children. Anesth Analg. 2007;104:528-531.

Gulhas N, Durmus M, Demirbilek S. The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study. Paediatr Anaesth. 2003;13:43-47.

Batra YK, Ivanova M, Ali SS. The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children. Pediatr Anesth. 2005;15:1094-1097.

Aouad MT, Yazbeck-Karam VG, Nasr VG. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevorane anesthesia. Anesthesiology. 2007;107:733-738.

Chia YY, Lee SW, Liu K. Propofol causes less postoperative pharyngeal morbidity than thiopental after the use of a laryngeal mask airway. Anesth Analg. 2008;106:123-126.

Lee CK, Chien TJ, Hsu JC. The effect of acupuncture on the incidence of postextubation laryngospasm in children. Anaesthesia. 1998;53:917-920.

Rassam R, Sandbythomas M, Vaughan RS. Airway management before, during and after extubation: a survey of practice in the United Kingdom and Ireland. Anaesthesia. 2005;60:995-1001.

Larson CP Jr. Laryngospasm: the best treatment. Anesthesiology. 1998;89:1293-1294.

Warner DO. Intramuscular succinylcholine and laryngospasm. Anesthesiology. 2001;95:1039-1040.

Walker RW, Sutton RS. Which port in a storm?: Use of suxamethonium without intravenous access for severe laryngospasm. Anaesthesia. 2007;62:757-759.

Donati F, Guay J. No substitute for the intravenous route. Anesthesiology. 2001;94:1-2.

Wisely NA, Mayall R. Intralingual succinylcholine injection provides a rapid onset of muscle relaxation in an emergency. Anaesthesia. 2001;56.

Owen H. Postextubation laryngospasm abolished by doxapram. Anaesthesia. 1982;37:1112-1114.

Sibai AN, Yamout I. Nitroglycerin relieves laryngospasm. Acta Anaesthesiol Scand. 1999;43:1081-1083.

Lee KW, Dowries JJ. Pulmonary edema secondary to laryngospasm in children. Anesthesiology. 1983;59:347-349.

Alb M, Tsagogiorgas C, Meinhardt JP. Negative-pressure pulmonary edema (NPPE). Anasthesiol Intensivmed Notfallmed Schmerzther. 2006;41:64-78.

Peixoto AJ. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: Relato de caso. Rev Bras Anestesiol. 2002;52:335-343.

Bisinotto FMB, Cardoso RP, Abud TMV. Edema agudo pulmonar associado à obstrução das vias aéreas: Relato de caso. Rev Bras Anestesiol. 2008;58:165-171.

Nascimento Jr P, Neves LBJ, Modolo NSP. Complicações respiratórias em crianças submetidas a anestesia geral. Rev Bras Anestesiol. 2000;50:345-349.

Larsen KM, Laursen RJ. Rupture of the stomach caused by manual ventilation during laryngospasm. Acta Anaesthesiol Scand. 1996;40:130-131.

Mausser G, Friedrich G, Schwarz G. Airway management and anesthesia in neonates, infants and children during endolaryngotracheal surgery. Pediatr Anesth. 2007;17:942-947.

Biro P, Priebe HJ. Staged extubation strategy: is an airway exchange catheter the answer?. Anesth Analg. 2007;105:1182-1185.

Tenório SB, Oliveira GS, Floriano KMS. Laringoespasmo e extubação traqueal em plano anestésico: estudo comparativo em crianças. Rev Bras Anestesiol. 1993;43:293-296.

Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Pediatr Anesth. 2008;18:303-307.

Burgoyne LL, Anghelescu DL. Intervention steps for treating laryngospasm in pediatric patients. Pediatr Anesth. 2008;18:297-302.

Alalami AA, Ayoub CM, Baraka AS. Laryngospasm: review of different prevention and treatment modalities. Pediatr Anesth. 2008;18:281-288.

Black AE. Laryngospasm in pediatric practice. Pediatr Anesth. 2008;18:279-280.

Flick RP, Wilder RT, Pieper SF. Risk factors for laryngospasm in children during general anesthesia. Pediatr Anesth. 2008;18:289-296.

Yellon RF. Prevention and managment of compications of airway surgery in children. Pediatr Anesth. 2004;14:107-111.

Laringoespasmo

Laryngospasm

Adriano Bechara de Souza Hobaika; Michele Nacur Lorentz

Resumo

Palavras-chave

Abstract

Keywords

References

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