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Aspirated food in larynx — Clinical Guidelines

Overview

Aspirated food in the larynx typically occurs during episodes of choking or aspiration events, leading to potential airway obstruction and respiratory distress. Prompt identification and management are crucial to prevent complications such as aspiration pneumonia or asphyxia.

Diagnosis

Clinical Presentation: Symptoms include coughing, choking, dyspnea, and potentially cyanosis.

Diagnostic Tools: Flexible laryngoscopy may be necessary to visualize aspirated material in the larynx 1.

Grading Systems: Cormack-Lehane (CL) classification can describe laryngeal view during laryngoscopy, though reliability varies among practitioners 2.

Management

Immediate Airway Management: Ensure airway patency; consider advanced airway techniques if necessary.

Laryngoscopy: Utilize appropriate laryngoscopes (e.g., Truview EVO2, Glidescope) for better visualization and intubation success 4 5.

Preoxygenation: Optimize preoxygenation duration based on age; infants and young children may require longer periods 6.

Pharmacological Support: Intratracheal aerosolized etidocaine can reduce cardiovascular and cough responses during laryngoscopy and intubation 8.

Special Populations

Pediatrics: Longer preoxygenation periods are recommended to achieve adequate oxygenation before laryngoscopy 6.

Elderly: Increased vigilance for complications due to potential comorbidities affecting airway management 5.

Key Recommendations

Utilize advanced laryngoscopes like Truview EVO2 or Glidescope for improved visualization during laryngoscopy and intubation (Evidence: Moderate 4 5).

Tailor preoxygenation duration based on patient age to ensure sufficient oxygenation before laryngoscopy (Evidence: Moderate 6).

Consider intratracheal aerosolized etidocaine to mitigate cardiovascular and respiratory responses during laryngoscopy and intubation in selected patients (Evidence: Weak 8).

References

1 Butler JJ, White SF, Myint CWM, Groves MW. The Feasibility of Utilizing Smartphone Flashlights as an Alternative Endoscopic Light Source in Emergency Situations. Ear, nose, & throat journal 2021. link 2 Krage R, van Rijn C, van Groeningen D, Loer SA, Schwarte LA, Schober P. Cormack-Lehane classification revisited. British journal of anaesthesia 2010. link 3 Correa JB, Dellazzana JE, Sturm A, Leite DM, de Oliveira Filho GR, Xavier RG. Using the Cusum curve to evaluate the training of orotracheal intubation with the Truview EVO2 laryngoscope. Revista brasileira de anestesiologia 2009. link 4 Malik MA, O'Donoghue C, Carney J, Maharaj CH, Harte BH, Laffey JG. Comparison of the Glidescope, the Pentax AWS, and the Truview EVO2 with the Macintosh laryngoscope in experienced anaesthetists: a manikin study. British journal of anaesthesia 2009. link 5 Mulcaster JT, Mills J, Hung OR, MacQuarrie K, Law JA, Pytka S et al.. Laryngoscopic intubation: learning and performance. Anesthesiology 2003. link 6 Morrison JE, Collier E, Friesen RH, Logan L. Preoxygenation before laryngoscopy in children: how long is enough?. Paediatric anaesthesia 1998. link 7 Cohen AM, Fleming BG, Wace JR. Grading of direct laryngoscopy. A survey of current practice. Anaesthesia 1994. link 8 Artru AA, Strumwasser TA. Intratracheal aerosolized etidocaine to attenuate cardiovascular and cough responses to laryngoscopy and intubation. Annals of emergency medicine 1985. link80922-7) 9 Lewis RB. Anaesthesia for laryngoscopy: a new method of ventilation. Anaesthesia 1977. link 10 Poling HE, Wolfson B, Siker ES. A technique of ventilation during laryngoscopy and bronchoscopy. British journal of anaesthesia 1975. link

Aspirated food in larynx