Combined Laryngospasm and Bronchospasm during Procedural Anesthesia

Case ReportThe following presents a case of a male active duty service member without any significant past medical history or allergies and no pulmonary risk factors who experienced a combined laryngospasm and bronchospasm at the beginning of a procedural sedation.A healthy 20-year-old male presented for routine wisdom teeth extraction and frenectomy under deep sedation at a hospital-based army Oral & maxillofacial surgery residency training program.The patient had no significant past medical history, allergies, or pre-operative risk factors suggestive for pulmonary concerns such a smoking, asthma, seasonal allergies, or a history of anesthetic complications.Prior to beginning the procedure, the resident surgeon-anesthetist presented their case to the attending surgeon and obtained permission to initiate deep sedation and surgery.The emergency medications and supply kit were brought into the procedure room.Consents, medication reconciliation, and time out protocol were completed per institution protocol.The patient reported he was very nervous for surgery, especially for the intravenous access and became visibly diaphoretic before starting.A cold compress was placed to forehead and the patient was positioned to his comfort.The patient then reported nausea.An intravenous catheter was placed, and the patient was administered Zofran 4mg, supplemental oxygen was applied at 3LPM via nasal cannula.Bluetooth precordial stethoscope was connected and remained