DOI QR코드

DOI QR Code

Laryngospasm following orthognathic surgery: an unusual case report

  • Hwaseon Lee (Department of Oral and Maxillofacial Surgery, Yongin Severance Hospital) ;
  • Hyunmi Jo (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry)
  • Received : 2024.06.27
  • Accepted : 2024.08.18
  • Published : 2024.10.31

Abstract

This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.

Keywords

References

  1. Gavel G, Walker RWM. Laryngospasm in anaesthesia. Contin Educ Anaesth Crit Care Pain 2014;14:47-51. https://doi.org/10.1093/bjaceaccp/mkt031
  2. Landsman IS. Mechanisms and treatment of laryngospasm. Int Anesthesiol Clin 1997;35:67-73. https://doi.org/10.1097/00004311-199703530-00008
  3. Alalami AA, Ayoub CM, Baraka AS. Laryngospasm: review of different prevention and treatment modalities. Paediatr Anaesth 2008;18:281-8. https://doi.org/10.1111/j.1460-9592.2008.02448.x
  4. Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Paediatr Anaesth 2008;18:303-7. https://doi.org/10.1111/j.1460-9592.2008.02446.x
  5. Janaszak-Jasiecka A, Siekierzycka A, Ploska A, Dobrucki IT, Kalinowski L. Endothelial dysfunction driven by hypoxia-the influence of oxygen deficiency on NO bioavailability. Biomolecules 2021;11:982. https://doi.org/10.3390/biom11070982
  6. Del Re DP. Mechanisms of ischemic heart injury. Cells 2022;11:1384. https://doi.org/10.3390/cells11091384
  7. Rutt AL, Bojaxhi E, Torp KD. Management of refractory laryngospasm. J Voice 2021;35:633-5. https://doi.org/10.1016/j.jvoice.2020.01.004
  8. Sibert KS, Long JL, Haddy SM. Extubation and the risks of coughing and laryngospasm in the era of coronavirus disease-19 (COVID-19). Cureus 2020;12:e8196. https://doi.org/10.7759/cureus.8196
  9. Chang WC. Negative-pressure pulmonary edema after laparoscopic appendectomy. JAAPA 2019;32:28-30. https://doi.org/10.1097/01.jaa.0000574524.09174.bb
  10. Al-alami AA, Zestos MM, Baraka AS. Pediatric laryngospasm: prevention and treatment. Curr Opin Anaesthesiol 2009;22:388-95. https://doi.org/10.1097/aco.0b013e32832972f3
  11. Blackwell SC, Hallak M, Hotra JW, Refuerzo J, Hassan SS, Sokol RJ, et al. Timing of fetal nucleated red blood cell count elevation in response to acute hypoxia. Biol Neonate 2004;85:217-20. https://doi.org/10.1159/000075808
  12. Devereaux PJ, Szczeklik W. Myocardial injury after non-cardiac surgery: diagnosis and management. Eur Heart J 2020;41:3083-91. https://doi.org/10.1093/eurheartj/ehz301
  13. Anupama BK, Chaudhuri D. A review of acute myocardial injury in coronavirus disease 2019. Cureus 2020;12:e8426. https://doi.org/10.7759/cureus.8426