Patients on ketamine can develop iatrogenic laryngospasm and hypersalivation.
Patients on ketamine can develop iatrogenic laryngospasm and hypersalivation. Ketamine is commonly used for induction, procedural sedation, and pain in the ED. Whenever we’re going on a trip, safety always first and we always assume the worst.
Laryngospasm is an abrupt spasm of the vocal cords that potentially completely obstructs the airway with subsequent hypoxemia and pulmonary edema. Risk factors include airway instrumentation, vocal cord irritation, and children. Laryngospasm is more likely to occurs in pediatrics and with intramuscular administration in comparison to adults.
Early identification and rapid intervention are important for management. Administer oxygen with a tight mask seal and Larson’s maneuver can be attempted, but thats out of my realm. I just bring the drugs. Most episodes are transient and can be resolved with airway alignment and supplemental oxygen or positive airway pressure.
In the setting of a complete laryngospasm, its going to get dicey. Deepen sedation with propofol as this may break the spasm. If not, paralytics are given where SUX is preferabble with a rapid onset and short duration. Can’t bag someone forever. We’ll give 0.25 to 0.5 mg/kg. Have some atropine on deck for succinycholine-induced bradycardia, especially in your pediatric patients. Ventilate with mask or endotrachael intubation. Make sure an induction and paralytic agent handy just in case you might need it. Did you check the #PHARMFAX? Check out my website at pharmwyze.com, and I hope you learned something new.
Recommended Read/Watch
Ketamine vs Etomidate: https://tinyurl.com/mrhexn59
Induction Agents: https://tinyurl.com/233b9zxp
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References
Green et al. Laryngospasm during emergency department ketamine sedation: a case-control study. Pediatr Emerg Care. 2010 Nov;26(11):798-802. doi: 10.1097/PEC.0b013e3181fa8737.
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