Identifying patients at higher risk for laryngospasm is crucial for ensuring that an adequate depth of anesthesia is achieved before any potentially triggering stimulus. Clear communication and coordination between the anesthesia and surgical teams are essential. The practice of surgeons confirming with the anesthesia provider before beginning the procedure should be maintained to minimize the risk of complications.
The risk of laryngospasm is greatest during induction and extubation due to fluctuating anesthesia levels. For induction, inhalation should be performed using a non-irritant agent such as sevoflurane, while IV induction with propofol tends to be smoother and less likely to cause issues.
During extubation, it is important to ensure the patient is either in a deep plane of anesthesia or fully awake; extubating in a partially awake state increases the risk of laryngospasm. This principle applies to both tracheal tubes and supraglottic airway devices (SADs). Although each method has its pros and cons, neither is definitively superior in preventing laryngospasm. When planning a deep extubation with a tracheal tube, the airway should be suctioned, and the patient placed in the lateral position. If the airway is clear, the patient should be left undisturbed after extubation.
For awake extubation, it should only be performed when the patient demonstrates clear signs of recovery, such as facial grimacing, adequate tidal volumes, a regular respiratory pattern, coughing, and preferably eye-opening. Avoiding stimulation of any kind until the patient has adequately emerged will reduce the incidence of post-extubation laryngospasm.
Additionally, extubating the trachea during forced positive pressure inflation can reduce the excitability of the laryngeal adductor muscles, thereby decreasing the likelihood of laryngospasm and helping to clear the airway of secretions or blood.
