Combined laryngospasm and bronchospasm during general anesthesia with i-gel® supraglottic airway: a case report

Abstract

Supraglottic airways (SGAs) are integral to airway management during general anesthesia. However, they can precipitate serious airway complications such as laryngospasm and bronchospasm, particularly when anesthesia is light or airway irritation occurs. We report a rare case of concurrent laryngospasm and bronchospasm following i-gel® insertion and describe the successful management.

A 55-year-old male was scheduled for general anesthesia for carpal tunnel release. He was a chronic smoker but had no underlying systemic diseases. An i-gel® was inserted after standard induction. Approximately 10 minutes into the surgery, the patient began

to hiccup, followed by inadequate ventilation and loss of end-tidal CO₂ tracing. Suspecting laryngospasm, the i-gel® was removed, and mask ventilation attempted. As ventilation remained poor, immediate endotracheal intubation was performed following succinylcholine administration. After intubation, severe wheezing was auscultated bilaterally, accompanied by low tidal volumes and high peak inspiratory pressures, consistent with bronchospasm. Intramuscular epinephrine was administered and resulted in rapid improvement in ventilation. Laryngospasm occurring during SGA use may concurrently trigger bronchospasm, warranting particular caution in smokers. This case underscores the importance of recognizing the complex nature of acute airway complications during SGA use and implementing prompt and appropriate management.

Keywords: i-gel®; supraglottic airway; laryngospasm; bronchospasm; epinephrine

Citation: Bak JW, Shin MJ, Kim GH, Kim SD, Huh J. Combined laryngospasm and bronchospasm during general anesthesia with i-gel® supraglottic airway: a case report. Anaesth. pain intensive care 2026;30(2):267-269. DOI: 10.35975/apic.v30i2.3136

Received: November 13, 2025; November 24, 2025: xxx; Accepted: November 27, 2025