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  • Print publication year: 2010
  • Online publication date: January 2011

Chapter 11 - Airway damage: iatrogenic and traumatic

from Section 2 - Clinical


An increase in the sensitivity of airway reflexes during induction of anaesthesia increases the likelihood of laryngeal spasm and coughing. Some early work identified two types of receptor in the larynx: one a slowly adapting receptor and the second a rapidly adapting receptor thought to be especially sensitive to chemical stimulants. Anaesthetic agents may sensitise the receptors, explaining why some inhaled and intravenous agents may easily precipitate laryngeal spasm. Prior to the administration of lidocaine airway irritation caused not only the cough reflex, but also other respiratory reflexes such as expiration, apnoea and spasmodic panting. It should be noted that the initial application of local anaesthetic agents to the airway may be associated with laryngospasm. It is now thought that the pharyngeal dilators, in addition to the diaphragm, comprise the efferent output of the respiratory centre. Tonic contraction is required to keep the tongue forward and maintain airway patency.

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Further reading

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JaenssonM, OlowssonLL, NilssonU. (2010). Endotracheal tube size and sore throat following surgery: A randomized-controlled study. Acta Anaesthesiologica Scandinavica, 54, 147–153.
JewettBS, ShockleyWW, RutledgeR. (1999). External laryngeal trauma analysis of 392 patients. Archives of Otolaryngology–Head & Neck Surgery, 125, 877–880.
KikuraM, SuzukiK, ItagakiT, TakadaT, SatoS. (2007). Age and comorbidity as risk factors for vocal cord paralysis associated with tracheal intubation. British Journal Anaesthesia 98, 524–530.
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MorfeyD, PatelA. (2008). Airway trauma. Anaesthesia and Intensive Care Medicine, 9, 312–314.
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NouraeiSA, MaE, PatelA, HowardDJ, SandhuGS. (2007). Estimating the population incidence of adult laryngo-tracheal stenosis. Clinical Otolaryngology, 32, 411–412.
NouraeiSA, SinghA, PatelA, FergusonC, HowardDJ, SandhuGS. (2006). Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope, 116, 1417–1421.
SandhuGS, NouraeiSA. (2009). Laryngeal and esophageal trauma. In: CummingsCW (Ed.), Cummings Otolaryngology Head & Neck Surgery. Chapter 70. Philadelphia: Elsevier/Mosby.
SchaeferSD. (1992). The acute management of external laryngeal trauma: A 27-year experience. Archives of Otolaryngology–Head & Neck Surgery, 118, 598–604.
TanakaA, IsonoS, IshikawaT, SatoJ, NishinoT. (2003). Laryngeal resistance before and after minor surgery, endotracheal tube versus laryngeal mask airway. Anesthesiology, 99, 252–258.