Laryngospasm in recovery
Aug 11, 2025
Airway lockdown – Recognition and Management of Laryngospasm in PACU
Laryngospasm is characterised by the involuntary closure of the vocal cords, often triggered by stimulation of the airway during emergence from anaesthesia. It is a potentially life-threatening complication that PACU/Recovery nurses must recognise and manage swiftly.
🔍 Detection
Early recognition is absolutely critical here, with unconscious patients requiring vigilant 1:1 nursing care. Key signs to look out for are:
🔸 Sudden inspiratory effort with little or no air movement despite chest rise
🔸 High-pitched inspiratory stridor (indicating partial spasm) or total silence (indicating complete spasm)
🔸 The use of accessory muscles
🔸 Rapid desaturation on pulse oximetry – bearing in mind that there is approximately 20–40 seconds of delay with peripheral pulse oximetry readings
🔸 Patient distress or agitation if semi-conscious
Risk factors include recent extubation or removal of LMA, presence of secretions and/or airway suctioning, airway surgery, or a history of reactive airway disease.
🛠 Immediate Management
🔸 Send for help – Alert your recovery team and press the emergency buzzer
🔸 Optimise airway positioning – ensure airway is optimally aligned and apply jaw thrust (provided it is safe to do so)
🔸 Positive pressure ventilation – Recovery bays should be equipped with a laerdal bag and peep valve. Use this to deliver 100% oxygen with continuous positive pressure
🔸 Prepare drugs – Members of the recovery team should prepare for the next steps of laryngospasm management by drawing up propofol (it’s generally advisable to have sux on hand too!)
🔸 Airway preparation – Equipment necessary for reintubation should be prepared and ready to go as well
🔸 Handover – Bear in mind, the responding anaesthetist/s may not be familiar with the patient, so it’s important to clearly declare the crisis at hand, and provide succinct handover of relevant information to ensure prompt and safe management of the situation
🩺 Post crisis care
Once the laryngospasm has resolved, the patient should be monitored closely for any:
🔹 Hypoxia
🔹 Airway swelling
🔹 Negative pressure pulmonary oedema
The event should be clearly documented in the patient history, and, depending on the severity of the event, discussion with the anaesthetic and surgical team should occur to determine ongoing care requirements and follow-up.
Swift recognition and management of laryngospasm can prevent a serious hypoxic event and further life-threatening complications from occurring. The role of the PACU nurse is vital in maintaining airway vigilance, and rapidly identifying and escalating concerns when needed.
Build Knowledge ✅
Improve Safety ✅
References:
Silva, C.R., Pereira, T., Henriques, D., Lanca, F. (2020). Comprehensive review of laryngospasm. WFSA. Accessed from https://resources.wfsahq.org/wp-content/uploads/New-Update-35-Laryngospasm.pdf
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.