Crisis management during anaesthesia: laryngospasm
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-obstr...
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| description | 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 |
| doi_str_mv | 10.1136/qshc.2002.004275 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1744026</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>19555137</sourcerecordid><originalsourceid>FETCH-LOGICAL-b527t-c97d1cdcbc7e7fac4c9bb258919b219e01f3ec32182dbde27592328102d36673</originalsourceid><addsrcrecordid>eNqFkUtLAzEUhYMovveupCC4kam5yWQycSHI-ASpKMVtyGTSNnUeNemI_ntTptbHxlVC7nfvPScHoQPAfQCanL76ie4TjEkf45hwtoa2IeYsogLD-tc9FekW2vF-ijEIImATbQETlFKMtxHJnPXW9ypVq7GpTD3vFa2z9bgXHoyfT4y36qxXKvdRjxs_U77aQxsjVXqzvzx30fD6apjdRvcPN3fZxX2UM8LnkRa8AF3oXHPDR0rHWuQ5YakAkRMQBsOIGk0JpKTICxPUC0JJCpgUNEk43UXn3dhZm1em0EGaU6WcOVsFMbJRVv6u1HYix82bBB7HmCRhwPFygGte2-BFVtZrU5aqNk3rZcJTEYuE_QuCYIwBXUg6-gNOm9bV4RPCUp5yDpxCoHBHadd478xopRmwXMQmF7HJRWyyiy20HP70-t2wzCkAUQdYPzfvq7pyL8EG5UwOnjOZZYPhJX2i8jHwJx2fV9P_138Cco2wVA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1778771731</pqid></control><display><type>article</type><title>Crisis management during anaesthesia: laryngospasm</title><source>MEDLINE</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Visvanathan, T ; Kluger, M T ; Webb, R K ; Westhorpe, R N</creator><creatorcontrib>Visvanathan, T ; Kluger, M T ; Webb, R K ; Westhorpe, R N</creatorcontrib><description>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.</description><identifier>ISSN: 1475-3898</identifier><identifier>EISSN: 1475-3901</identifier><identifier>DOI: 10.1136/qshc.2002.004275</identifier><identifier>PMID: 15933300</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Airway management ; airway obstruction ; Algorithms ; anaesthesia complications ; Anesthesia ; Anesthesia - adverse effects ; Anesthesiology - methods ; Anesthesiology - standards ; Australia ; Cardiac arrhythmia ; crisis management ; desaturation ; Emergencies ; Health administration ; Humans ; hypoxia ; Intraoperative Complications - therapy ; Intubation ; Laryngismus - etiology ; Laryngismus - therapy ; laryngospasm ; Manuals as Topic ; Monitoring, Intraoperative ; Morbidity ; Mortality ; Original ; Physiology ; pulmonary aspiration ; pulmonary oedema ; Respiration ; Risk Management ; Surgery ; Task Performance and Analysis ; Ventilation ; Vomiting</subject><ispartof>Quality & safety in health care, 2005-06, Vol.14 (3), p.e3-e3</ispartof><rights>Copyright 2005 Quality and Safety in Health Care</rights><rights>Copyright: 2005 Copyright 2005 Quality and Safety in Health Care</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b527t-c97d1cdcbc7e7fac4c9bb258919b219e01f3ec32182dbde27592328102d36673</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744026/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744026/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27922,27923,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15933300$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Visvanathan, T</creatorcontrib><creatorcontrib>Kluger, M T</creatorcontrib><creatorcontrib>Webb, R K</creatorcontrib><creatorcontrib>Westhorpe, R N</creatorcontrib><title>Crisis management during anaesthesia: laryngospasm</title><title>Quality & safety in health care</title><addtitle>Qual Saf Health Care</addtitle><description>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.</description><subject>Airway management</subject><subject>airway obstruction</subject><subject>Algorithms</subject><subject>anaesthesia complications</subject><subject>Anesthesia</subject><subject>Anesthesia - adverse effects</subject><subject>Anesthesiology - methods</subject><subject>Anesthesiology - standards</subject><subject>Australia</subject><subject>Cardiac arrhythmia</subject><subject>crisis management</subject><subject>desaturation</subject><subject>Emergencies</subject><subject>Health administration</subject><subject>Humans</subject><subject>hypoxia</subject><subject>Intraoperative Complications - therapy</subject><subject>Intubation</subject><subject>Laryngismus - etiology</subject><subject>Laryngismus - therapy</subject><subject>laryngospasm</subject><subject>Manuals as Topic</subject><subject>Monitoring, Intraoperative</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Original</subject><subject>Physiology</subject><subject>pulmonary aspiration</subject><subject>pulmonary oedema</subject><subject>Respiration</subject><subject>Risk Management</subject><subject>Surgery</subject><subject>Task Performance and Analysis</subject><subject>Ventilation</subject><subject>Vomiting</subject><issn>1475-3898</issn><issn>1475-3901</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkUtLAzEUhYMovveupCC4kam5yWQycSHI-ASpKMVtyGTSNnUeNemI_ntTptbHxlVC7nfvPScHoQPAfQCanL76ie4TjEkf45hwtoa2IeYsogLD-tc9FekW2vF-ijEIImATbQETlFKMtxHJnPXW9ypVq7GpTD3vFa2z9bgXHoyfT4y36qxXKvdRjxs_U77aQxsjVXqzvzx30fD6apjdRvcPN3fZxX2UM8LnkRa8AF3oXHPDR0rHWuQ5YakAkRMQBsOIGk0JpKTICxPUC0JJCpgUNEk43UXn3dhZm1em0EGaU6WcOVsFMbJRVv6u1HYix82bBB7HmCRhwPFygGte2-BFVtZrU5aqNk3rZcJTEYuE_QuCYIwBXUg6-gNOm9bV4RPCUp5yDpxCoHBHadd478xopRmwXMQmF7HJRWyyiy20HP70-t2wzCkAUQdYPzfvq7pyL8EG5UwOnjOZZYPhJX2i8jHwJx2fV9P_138Cco2wVA</recordid><startdate>20050601</startdate><enddate>20050601</enddate><creator>Visvanathan, T</creator><creator>Kluger, M T</creator><creator>Webb, R K</creator><creator>Westhorpe, R N</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Group</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7T2</scope><scope>7U2</scope><scope>C1K</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20050601</creationdate><title>Crisis management during anaesthesia: laryngospasm</title><author>Visvanathan, T ; Kluger, M T ; Webb, R K ; Westhorpe, R N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b527t-c97d1cdcbc7e7fac4c9bb258919b219e01f3ec32182dbde27592328102d36673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Airway management</topic><topic>airway obstruction</topic><topic>Algorithms</topic><topic>anaesthesia complications</topic><topic>Anesthesia</topic><topic>Anesthesia - adverse effects</topic><topic>Anesthesiology - methods</topic><topic>Anesthesiology - standards</topic><topic>Australia</topic><topic>Cardiac arrhythmia</topic><topic>crisis management</topic><topic>desaturation</topic><topic>Emergencies</topic><topic>Health administration</topic><topic>Humans</topic><topic>hypoxia</topic><topic>Intraoperative Complications - therapy</topic><topic>Intubation</topic><topic>Laryngismus - etiology</topic><topic>Laryngismus - therapy</topic><topic>laryngospasm</topic><topic>Manuals as Topic</topic><topic>Monitoring, Intraoperative</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Original</topic><topic>Physiology</topic><topic>pulmonary aspiration</topic><topic>pulmonary oedema</topic><topic>Respiration</topic><topic>Risk Management</topic><topic>Surgery</topic><topic>Task Performance and Analysis</topic><topic>Ventilation</topic><topic>Vomiting</topic><toplevel>online_resources</toplevel><creatorcontrib>Visvanathan, T</creatorcontrib><creatorcontrib>Kluger, M T</creatorcontrib><creatorcontrib>Webb, R K</creatorcontrib><creatorcontrib>Westhorpe, R N</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Quality & safety in health care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Visvanathan, T</au><au>Kluger, M T</au><au>Webb, R K</au><au>Westhorpe, R N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Crisis management during anaesthesia: laryngospasm</atitle><jtitle>Quality & safety in health care</jtitle><addtitle>Qual Saf Health Care</addtitle><date>2005-06-01</date><risdate>2005</risdate><volume>14</volume><issue>3</issue><spage>e3</spage><epage>e3</epage><pages>e3-e3</pages><issn>1475-3898</issn><eissn>1475-3901</eissn><abstract>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.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>15933300</pmid><doi>10.1136/qshc.2002.004275</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Airway management airway obstruction Algorithms anaesthesia complications Anesthesia Anesthesia - adverse effects Anesthesiology - methods Anesthesiology - standards Australia Cardiac arrhythmia crisis management desaturation Emergencies Health administration Humans hypoxia Intraoperative Complications - therapy Intubation Laryngismus - etiology Laryngismus - therapy laryngospasm Manuals as Topic Monitoring, Intraoperative Morbidity Mortality Original Physiology pulmonary aspiration pulmonary oedema Respiration Risk Management Surgery Task Performance and Analysis Ventilation Vomiting |
| title | Crisis management during anaesthesia: laryngospasm |
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