In adult Ketamine-associated laryngospasm (stridor), what is the recommended sequence of interventions?

• A. Nebulized albuterol; oxygen; proceed to intubation
• B. High flow O2; BVM; Rapid Sequence Intubation
• C. Immediate intubation without oxygen
• D. Place patient in Trendelenburg

Answer: (B)

The main idea here is to protect oxygenation and then secure the airway in ketamine-associated laryngospasm. Start with high-flow oxygen to maximize oxygen delivery during the spasm. If ventilation remains difficult, use bag-valve-mask ventilation to provide breaths and help relieve the obstruction while you prepare further treatment. If the patient still cannot be adequately oxygenated or ventilated, proceed to rapid sequence intubation to definitively secure the airway and minimize aspiration risk. This sequence emphasizes maintaining oxygenation and ventilation first, with definitive airway control as the next step if needed. Other approaches don’t address immediate oxygen delivery or airway security in this scenario: bronchodilators don’t fix laryngospasm, intubating without ensuring oxygenation can worsen hypoxemia, and extreme positioning doesn’t resolve the airway obstruction.