Catastrophic laryngeal and/or glottic edema with acute respiratory failure can occur rarely. This is a life-threatening situation that demands immediate securing of an airway. Patients who have been intubated for a prolonged period of time (such as
Table 27.4. Prevention and treatment of magnesium toxicity
Monitor urine output, maternal respiration, patellar reflexes
Serum magnesium levels (in certain cases)
Infusion of intravenous magnesium in a buretrol-type system
Respiratory support as determined by clinical indicators (respiratory rate, SpO2) Continuous cardiac monitoring Infusion of calcium salts Loop or osmotic diuretics
Recognition that toxic magnesium is neither anesthetic nor amnestic to the patient may occur after status eclampticus) are at particular risk for this complication. Visualization of the larynx prior to extubation is important and if there is evidence of edema or swelling removal of the endotracheal tube should be delayed. Obviously, in such patients, it is essential that the eclampsia be controlled prior to extubation to reduce the need for re-intubation which may be very difficult with laryngeal or glottic edema.
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