The management and treatment of recurrent postoperative laryngospasm.

L aryngospasm is a common complication of airway management in anesthetic practice (1). It consists of a prolonged glottic closure reflex mediated by the superior laryngeal nerve. It often occurs with insufficient depth of anesthesia on endotracheal intubation, light anesthesia on tracheal extubation, or a combination of either of the preceding with an airway irritant such as blood, mucus, laryngoscope blade, suction catheter, surgical debris, or other foreign body. The management of laryngospasm described by many authors (2-4) consists of positive pressure ventilation, occasional small intravenous doses of succinylcholine or lidocaine, decreasing or increasing the depth of anesthesia, or tracheal reintubation with extubation after the patient is fully awake and thoroughly suctioned. Partial laryngospasm has some degree of air movement and may be difficult to distinguish from other causes of upper airway obstruction. Complete laryngospasm presents with no air movement and is a cause of postoperative negative pressure pulmonary edema (5,6). If there is a history of choking during sleep, a sleep evaluation and polysomnography may be indicated (7). We present a case of awake recurrent complete postextubation laryngospasm and its management in an adult male after general endotracheal anesthesia for a mandibular advancement procedure.