SEVERE LARYNGOSPASM IN THE RECOVERY ROOM: RISK FACTORS, PREVENTION, AND EVIDENCE-BASED STEPWISE MANAGEMENT. CASE REPORT

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0810

Abstract

Background: Post-extubation laryngospasm in the postanesthesia care unit (PACU) is a time-critical airway emergency. While many episodes respond to basic maneuvers, severe events may rapidly evolve into profound hypoxemia, bradycardia, negative pressure pulmonary edema and the need for reintubation if escalation is delayed. Case report: A 46-year-old man with class I obesity, active smoking and high suspicion of obstructive sleep apnea underwent laparoscopic cholecystectomy under general anesthesia. Within minutes of PACU admission, he developed abrupt inspiratory obstruction with marked retractions, ineffective ventilation and rapid oxygen desaturation. A stepwise approach was implemented: removal of triggers and suctioning, jaw thrust, CPAP with 100% oxygen, deepening anesthesia with propofol, and—due to refractory hypoxemia—low-dose succinylcholine, which restored effective ventilation. He subsequently developed dyspnea and frothy sputum, with imaging consistent with negative pressure pulmonary edema, which resolved with non-invasive ventilatory support and ICU observation. Conclusions: Preoperative risk recognition, smooth extubation strategies and a clear PACU escalation algorithm are key to prevent major complications. Early neuromuscular blockade—including subparalytic succinylcholine—may be pivotal in severe cases to reverse glottic closure and prevent further deterioration.

Keywords: laryngospasm; postanesthesia care unit; extubation; postoperative respiratory complications; negative pressure pulmonary edema; succinylcholine; propofol.