To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter presents the most common pediatric surgery, myringotomy and ear tube placement. The author reviews in the indications for eat tubes in the setting of a child with upper respiratory tract infection. The perioperative considerations for upper respiratory tract infection are considered with relation to case postponement.
This chapter provides an overview of pediatric asthma. The author reviews the pathophysiology, precipitating factors and clinical symptoms of asthma. The preoperative plan for patients with asthma is reviewed. A comprehensive discussion on anesthetics for the asthmatic is presented as is the management of perioperative asthma exacerbation. Each of the medications commonly used for pediatric asthma are reviewed.
The incidence of difficult airway is higher in patients undergoing ENT surgery and, specifically, in patients undergoing ENT cancer surgery. Even the process of topicalization with local anesthetic can precipitate loss of the airway, as can some of the complications associated with awake intubation (e.g. airway bleeding and laryngospasm). The preoperative interview should also address the possibility of events having occurred since the last anesthetic such as weight gain, laryngeal stenosis from previous airway intervention, airway radiation, facial cosmetic surgery, and worsening temporomandibular joint disorder or rheumatoid arthritis. Prior to awake intubation, premedication is commonly used to reduce secretions, enable adequate topicalization of the airway, reduce the risk of epistaxis, and protect against the risk of aspiration. Depending on the clinical circumstance, intravenous sedation may be useful in allowing the patient to tolerate awake intubation by providing anxiolysis, amnesia, and analgesia.
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.
An extubation plan should always be formulated. Extubation in a deep plane of anaesthesia is an advanced technique. One-third of aspiration events occur after extubation. Every extubation technique should ensure minimal interruption in the delivery of oxygen to the patient's lungs, and should extubation fail, ventilation should be achievable with the minimal difficulty or delay. The choice of extubation position reflects a balance between the risks of vomiting post-extubation, and subsequent inhalation and soiling of the lungs, and potential respiratory embarrassment and ease of assisting ventilation. The depth of anaesthesia at the time of extubation is highly important because of the risk of life-threatening laryngospasm. Peri-extubation insertion of a laryngeal mask airway (LMA) is a useful technique for airway maintenance in the recovery period with less airway obstruction and coughing, and higher saturations than either deep or awake extubation. An airway exchange catheter (AEC) is a useful aid.
(1) To present a rare case of stridor secondary to prolonged laryngospasm in a patient with Parkinson's disease, and (2) to review the literature on stridor in Parkinson's disease.
We report a 73-year-old Parkinson's disease patient who developed acute stridor due to prolonged laryngospasm triggered by overspill of excessive secretions. The literature was reviewed, following a Medline search using the keywords ‘Parkinson's disease’ and ‘stridor’ or ‘airway obstruction’ or ‘laryngospasm’ or ‘laryngeal dystonia’ or ‘bilateral vocal cord palsy’.
Only 12 previously reported cases of stridor in Parkinson's disease patients were identified. Causes included bilateral vocal fold palsy (eight cases), laryngospasm (five), and dystonia of the jaw and neck muscles (two). The mechanism of laryngospasm in our patient was similar to ‘dry drowning’, and has not previously been described.
Laryngospasm can be triggered in Parkinson's disease by excessive secretions entering the larynx. The mechanism is similar to ‘dry drowning’. Treatment focuses on reducing secretions. The use of botulinum toxin to reduce spasm is inappropriate in this situation. This case emphasises the importance of recognising different causes of stridor in Parkinson's disease patients, as this affects management.
To review the presentation, risk factors and management of paroxysmal laryngospasm.
Retrospective review of cases.
A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.
All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.
Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56±6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.
The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.
Email your librarian or administrator to recommend adding this to your organisation's collection.