Airway management in Ludwig's angina

Anaesth Intensive Care. 1999 Dec;27(6):659-61. doi: 10.1177/0310057X9902700323.


A 37-year-old 91 kg man presented with features of Ludwig's angina. Anaesthesia for incision and drainage of his submandibular abscess was undertaken by two specialist anaesthetists with an otorhinolaryngological surgeon prepared for immediate tracheostomy. After preoxygenation, gas induction with sevoflurane in oxygen was followed by a gush of pus into the oral cavity and laryngospam causing acute upper airway obstruction. This resolved with 25 mg of suxamethonium and an endotracheal tube was passed into the trachea with difficulty. Options for management of the difficult airway in Ludwig's angina are discussed.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Airway Obstruction / etiology
  • Airway Obstruction / therapy*
  • Humans
  • Intubation, Intratracheal
  • Laryngismus / drug therapy
  • Laryngismus / etiology
  • Ludwig's Angina / complications*
  • Ludwig's Angina / therapy
  • Male
  • Neuromuscular Depolarizing Agents / therapeutic use
  • Succinylcholine / therapeutic use
  • Tracheostomy


  • Neuromuscular Depolarizing Agents
  • Succinylcholine