A patient in the recovery room develops stridor, accessory muscle use, and paradoxical chest-abdomen movement 20 minutes after extubation following a 3-hour neck dissection. The MOST likely diagnosis is:
- A Anaphylaxis to analgesics given in recovery
- B Post-extubation negative-pressure pulmonary oedema (NPPE)
- C Post-extubation laryngospasm from wound-related irritant ✓
- D Residual neuromuscular blockade causing inadequate respiratory effort
Explanation
Post-extubation laryngospasm is a reflex glottic closure triggered by secretions, blood, or wound irritants stimulating laryngeal receptors in the context of neck surgery. It typically presents within minutes of extubation with inspiratory stridor and paradoxical chest-abdomen movements (due to against-closed-glottis efforts). Treatment is CPAP/positive pressure via face mask, sublingual or IV succinylcholine 0.1–0.2 mg/kg for partial laryngospasm, or full RSI dose for complete spasm. Residual paralysis causes generalised weakness without stridor; NPPE follows relief of acute obstruction; anaphylaxis would have additional features.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.