border: none; Qual Saf Health Care 2005; 14:e3, Fernandez E, Williams DG: Training and the European Working Time Directive: A 7 year review of paediatric anaesthetic trainee caseload data. Their motoneurons are located in the brainstem nucleus ambiguous and the adjacent nucleus retroambigualis. Mayo Clinic. Other pharmacologic agents have been proposed for the prevention and/or treatment of laryngospasm, including magnesium,17doxapram,67diazepam,68and nitroglycerine.69However, because of the small number of patients included in these series no firm conclusions can be drawn. 2012 Aug;117(2):441-2. doi: 10.1097/ALN.0b013e31825f02b4. 2012 Feb;116(2):458-71. doi: 10.1097/ALN.0b013e318242aae9. A characteristic crowing noise may be heard in partial laryngospasm but will be absent in complete laryn-gospasm. PERIOPERATIVE laryngospasm is an anesthetic emergency that is still responsible for significant morbidity and mortality in pediatric patients.1It is a relatively frequent complication that occurs with varying frequency dependent on multiple factors.2,,5Once the diagnosis has been made, the main goals are identifying and removing the offending stimulus, applying airway maneuvers to open the airway, and administering anesthetic agents if the obstruction is not relieved. 1998 Nov;89(5):1293-4. Collins S, Schedler P, Veasey B, Kristofy A, McDowell M. Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection? However, if youve experienced laryngospasms in the past, your healthcare provider can determine whats causing them and find ways to reduce your risk. In this case, some equipment has high usage demands and becomes scarce throughout the unit. J Clin Anesth 2007; 19:51722, Kuduvalli PM, Jervis A, Tighe SQ, Robin NM: Unanticipated difficult airway management in anaesthetised patients: A prospective study of the effect of mannequin training on management strategies and skill retention. Khanna S (expert opinion). include protected health information. He had been fasting for the past 6 h. Preoperative evaluation was normal (systemic blood pressure 85/50 mmHg, heart rate 115 beats/min, pulse oximetry [SpO2] 99% on room air). Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children (17.4/1,000) than in the general population (8.7/1,000).2,5,,7In fact, the incidence of laryngospasm has been found to range from 1/1,000 up to 20/100 in high-risk surgery (i.e. This is because your vocal cords are contracted and closed tight during a laryngospasm. The progressive signs and symptoms are shivering (36C), confusion, disorientation, introversion (35C), amnesia (34C), cardiac arrhythmias (33C), clouding of consciousness (33-30C), LOC (30C), ventricular fibrillation (VF) (28C), and death (25C). The efficacy of lidocaine to either prevent or control extubation laryngospasm has been studied since the late 1970s.62Some articles have confirmed the efficacy of lidocaine for preventing postextubation laryngospasm, whereas others have found the opposite results to be true.16,63,,65A recent, well-conducted, randomized placebo-controlled trial in children undergoing cleft palate surgery demonstrated the effectiveness of IV lidocaine (1.5 mg/kg administered 2 min after tracheal extubation) in reducing laryngospasm and coughing (by 29.9% and 18.92%, respectively).64However, these favorable results were not confirmed in other studies.5,65The role of lidocaine (IV or topical) in preventing laryngospasm is still controversial. The goal is to slow your breathing and allow your vocal cords to relax. In reports addressing respiratory adverse events, including laryngospasm, the overall incidence of perioperative respiratory events as well as the incidence of laryngospasm was higher in 01-yr-old infants in comparison with older children.2,5,,7The risk of perioperative respiratory adverse event was quoted as decreasing by 8% for each increasing year of age.2A recent large cohort study confirmed this inverse relationship between age and risk of perioperative respiratory adverse events.5This study showed that the relative risk for perioperative respiratory adverse events, particularly laryngospasm, decreased by 11% for each yearly increase in age.5. Understanding the mechanics of laryngospasm is crucial for proper treatment. Am J Respir Crit Care Med 1998; 157:81521, von Ungern-Sternberg BS, Boda K, Schwab C, Sims C, Johnson C, Habre W: Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. More specifically, laryngeal closure reflex involves the laryngeal intrinsic muscles responsible for vocal folds adduction, i.e. For example, you might be able to exhale and cough, but have difficulty breathing in. Furthermore, the efficacy of propofol to break complete laryngospasm when bradycardia is present has been questioned.4In our case, two bolus doses of 5 mg IV propofol (each representing a dose of 0.6 mg/kg) were administered but did not relieve airway obstruction. Therefore, giving IV atropine before IV injection of suxamethonium to treat laryngospasm is mandatory.66. Complete airway obstruction is characterized by: Where is the laryngospasm notch? Laryngospasm is identied by varying degrees of airway obstruction with paradoxical chest move-ment, intercostal recession and tracheal tug. PubMed PMID: Orliaguet GA, Gall O, Savoldelli GL, Couloigner V. Case scenario: perianesthetic management of laryngospasm in children. Laryngospasm (luh-RING-o-spaz-um) is a condition in which your vocal cords suddenly spasm (involuntarily contract or seize). CPAP = continuous positive airway pressure; FiO2= fractional inspired oxygen tension; IM = intramuscular; PACU = postanesthesia care unit. In: Murray and Nadel's Textbook of Respiratory Medicine. It may be difficult for a nonspecialist pediatric anesthesiologist to adequately manage an inhalational induction, because of the possibility to fail to manage the airway properly or the inability to recognize and treat early a stridor/laryngospasm. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. Anesthesiology. The purpose of this case scenario is to highlight key points essential for the prevention, diagnosis, and treatment of laryngospasm occurring during anesthesia. GillesA. Orliaguet, Olivier Gall, GeorgesL. Savoldelli, Vincent Couloigner, Bruno Riou; Case Scenario: Perianesthetic Management of Laryngospasm in Children. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis.3,5,7In both partial and complete laryngospasm, signs of varying degrees of airway obstruction, such as suprasternal retraction, supraclavicular retractions, tracheal tug, paradoxical chest, and abdominal movements may be seen.3In addition, inspiratory stridor may be heard in partial laryngospasm but is absent in complete spasm. Dry drowning has been explained by mechanisms such as protracted laryngospasm and vagally mediated cardiac arrest triggered by contact of liquid with the upper airways. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Anesth Analg 1998; 86:70611, Flick RP, Wilder RT, Pieper SF, van Koeverden K, Ellison KM, Marienau ME, Hanson AC, Schroeder DR, Sprung J: Risk factors for laryngospasm in children during general anesthesia. There is a problem with A 0.2-mg IV bolus dose of atropine was injected and IV succinylcholine was given at a dose of 16 mg, followed by tracheal intubation. The purpose of this case scenario is to highlight keypoints essential for the prevention, diagnosis, and treatmentof laryngospasm occurring during anesthesia. Copyright 2012, the American Society of Anesthesiologists, Inc. Perianesthetic Management of Laryngospasm in Children, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0b013e318242aae9, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Perianesthetic Dental Injuries : Frequency, Outcomes, and Risk Factors, Understanding the Mechanics of Laryngospasm Is Crucial for Proper Treatment, Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane. Difficulty breathing ( dyspnea) Fatigue and exhaustion are other less-common and more subtle symptoms that may be associated with bronchospasm. For laryngeal closure reflex, several types of receptors can be distinguished, according to their specific sensitivities to cold, pressure, laryngeal motion, and chemical agents.19,21The chemoreceptors are sensitive to fluids with low chloride or high potassium concentrations, as well as to strong acidic or alkaline solutions.19,21. suggests that maintenance with sevoflurane was associated with a higher incidence of laryngospasm compared with propofol (relative risk 2.37, 95% CI 1.493.76; P< 0.0001).5In our case, the second episode of laryngospasm occurred while the patient was under light anesthesia. | INTENSIVE | RAGE | Resuscitology | SMACC. Usually, laryngospasm resolves and the patient recovers quickly without any sequelae. Both conditions result in sudden, frightening spasms and both conditions can temporarily affect your ability to breathe and speak. } ANESTHESIOLOGY 1981; 55:599602, Walker RW, Sutton RS: Which port in a storm? In children, an artificial cough maneuver, including a single lung inflation maneuver with 100% O2immediately before removal of the ETT, is useful at the time of extubation because it delays or prevents desaturation in the first 5 min after extubation in comparison with a suctioning procedure.36Although not demonstrated in this study, this technique could reduce laryngospasm because when the endotracheal tube leaves the trachea, the air escapes in a forceful expiration that removes residual secretions from the larynx. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Because laryngospasm is a potential life-threatening postoperative event, the PACU nurse 5 Many high-acuity medical conditions can induce these. ANESTHESIOLOGY 2001; 95:103940, Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL: Dose response to intramuscular succinylcholine in children. Anaphylaxis (+/- Laryngospasm) A 7-year-old male presents with wheeze, rash and increased WOB after eating a birthday cake. information submitted for this request. Necessary cookies are absolutely essential for the website to function properly. Muscles involved: lateral cricoarytenoid, thyroarytenoids (both from recurrent laryngeal), crycrothyroid (from external branch of superior laryngeal). Pulmonary complications. Otolaryngol Head Neck Surg 1998; 118:8802, Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO: The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: A preliminary study. Epidemiology of Laryngospasm in Pediatric Patients Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children 1,000).2,5-7 In fact, the incidence of laryngospasm has been gery (i.e., otolaryngology surgery).2,5-7 Many factors may increase the risk of laryngospasm. [Laryngospasm]. 2. Alterations of upper airway reflexes may occur in several conditions. Learn how your comment data is processed. Assist the patient's inspiratory effort with posi-tive-pressure ventilation with 100% oxygen. Common presenting signs and symptoms include tachypnea, tachycardia, diaphoresis, trembling, palpitations, shortness of breath and chest pain. . However, the acquisition and the mastering of these skills during specialty training and their maintenance during continuing medical education represent a formidable challenge. From: Encyclopedia of . We decided to omit it in the preventive and/or treatment algorithms of laryngospasm, although other authors have included it.3,8,66. Minimally invasive anti-reflux procedures, Advertising and sponsorship opportunities. Suxamethonium injection in a hypoxic patient may lead to severe bradycardia and even to cardiac arrest. Paediatr Anaesth 2008; 18:3037. Causes: hypocalcemia, painful stimuli . Laryngospasm (luh-RING-go-spaz-um) is a transient and reversible spasm of the vocal cords that temporarily makes it difficult to speak or breathe. Best Pract Res Clin Anaesthesiol 2005; 19:71732, McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ: A critical review of simulation-based medical education research: 20032009. } Such a conservative attitude has already been proposed for otolaryngology patients, whose surgery is expected to have an effect on the recurrence of URI episodes.11Premedication with anticholinergic agents may decrease secretions but has no demonstrated influence on the incidence of laryngospasm.7,29. #mc-embedded-subscribe-form input[type=checkbox] { Laryngospasm is an emergency situation and must be promptly recognized. Among all upper airway reflexes, it is the most resistant to deepening anesthesia, whereas the coughing reflex is the most sensitive. have demonstrated an increased risk for laryngospasm only when cold symptoms were present on the day of surgery or less than 2 weeks before.28This finding was recently confirmed by the same team in an extensive study involving 9,297 surgical procedures.5Rescheduling patient 23 weeks after an URI episode appears to be a safe approach. health information, we will treat all of that information as protected health Relaxation and breathing techniques may relieve symptoms and lessen the frequency or severity of laryngospasms in the future. Experimental evidences and anecdotal reports indicate that intraosseous and IV injection behave similarly, resulting in adequate intubating conditions within 45 s (1 mg/kg).57In children in whom succinylcholine is contraindicated, rocuronium administered at a dose of two to three times the ED95(0.9 to 1.2 mg/kg) may represent a reasonable substitute when rapid onset is needed.58,,60In addition, there is a possibility to quickly reverse the neuromuscular blockade induced by rocuronium using sugammadex if necessary.61. Singapore Med J 1998; 39:32830, Warner DO: Intramuscular succinylcholine and laryngospasm. He coordinates the Alfred ICUs education and simulation programmes and runs the units educationwebsite,INTENSIVE. The mother volunteered that he was exposed to passive smoking in the home. Paediatr Anaesth 2002; 12:1405, Plaud B, Meretoja O, Hofmockel R, Raft J, Stoddart PA, van Kuijk JH, Hermens Y, Mirakhur RK: Reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. PubMed PMID: 19669024. Paediatr Anaesth 2002; 12:7629, Tait AR, Pandit UA, Voepel-Lewis T, Munro HM, Malviya S: Use of the laryngeal mask airway in children with upper respiratory tract infections: A comparison with endotracheal intubation. This paper discusses a case study where the patient had laryngospasm, it also looks at the pathophysiology, risk factors and management of . information and will only use or disclose that information as set forth in our notice of width: auto; First, the introduction of working hour limitations in virtually all Western countries has decreased the number of pediatric cases performed by trainees.71Second, most anesthetics given to children are administered by nonspecialists whose lack of experience and inability to maintain their skill set for children is a problem. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. However, children younger than 3 yr may develop 510 URI episodes per year. Search for other works by this author on: Bhananker SM, Ramamoorthy C, Geiduschek JM, Posner KL, Domino KB, Haberkern CM, Campos JS, Morray JP: Anesthesia-related cardiac arrest in children: Update from the Pediatric Perioperative Cardiac Arrest Registry. Description The patient requires intubation, but isn't actively crashing. In case of sale of your personal information, you may opt out by using the link. If these medications help, please consult your doctor before taking them long term. This topic is beyond the scope of this article but was recently described elsewhere.37Eighty percent of negative pressure pulmonary edema cases occur within min after relief of the upper airway obstruction, but delayed onset is possible with cases reported up to 46 h later. Plan A:" 3.5 ETT ready, size 1 Macintosh laryngoscope blade" Small orange Bougie (pre bent), have a size 1 Miller blade available" Have a shoulder roll ready, but I wont put it in place" Have a white guedel airway available if I am having difculty with ventilation" If that doesnt work I will do the 2 person technique" Laryngospasm, particularly during inhalational induction and after extubation, is an important cause of apnea that all anesthesiologists who care for pediatric patients should understand and anticipate. Paediatr Anaesth 2008; 18:297302, Cohen MM, Cameron CB: Should you cancel the operation when a child has an upper respiratory tract infection? Many describe a choking sensation. Anesth Analg 2007; 104:26570, Bordet F, Allaouchiche B, Lansiaux S, Combet S, Pouyau A, Taylor P, Bonnard C, Chassard D: Risk factors for airway complications during general anaesthesia in paediatric patients. Eur Respir J 2001; 17:123943, Holm-Knudsen RJ, Rasmussen LS: Paediatric airway management: Basic aspects. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. More needed than oxygen! This site uses Akismet to reduce spam. Here are some important features to keep in mind: Complete blockage may present as just apnea; Can be preceded by high-pitched inspiratory stridor, followed by complete airway obstruction Pulm Pharmacol 1996; 9:3437, Shannon R, Baekey DM, Morris KF, Lindsey BG: Ventrolateral medullary respiratory network and a model of cough motor pattern generation. stroke, hypoxic encephalopathy), Attempt to break the laryngospasm by applying painful inward and anterior pressure at , If hypoxia supervenes consider administering, Laryngospasm is usually brief and may be followed by a. Second-level studies attempt to document the transfer of skills to the clinical setting and patient care. Recently, a new technique with gentle chest compression has been proposed as an alternative to standard practice for relief of laryngospasm.47In this before-after study, extubation laryngospasm was managed with standard practice (CPAP and gentle positive pressure ventilation via a tight-fitting facemask with 100% O2via facemask) during the first 2 yr of the study, whereas in the following 2 yr, laryngospasm was managed with 100% O2and concurrent gentle chest compression. In most cases, a laryngospasm lasts for up to one minute, but it may feel much longer. If breathing exercises and pushing on your laryngospasm notch dont relieve your symptoms, call 911 or head to the nearest emergency room. ANESTHESIOLOGY 2010; 12:98592, McGaghie WC: Medical education research as translational science. 1).3The second step relies on the emergent treatment of established laryngospasm occurring despite precautions (fig. Anesthesiology 2012; 116:458471 doi: https://doi.org/10.1097/ALN.0b013e318242aae9. Laryngospasm is a frightening condition that happens when your vocal cords suddenly seize up, making breathing more difficult. If you have recurring laryngospasms, schedule an appointment with a healthcare provider who specializes in laryngology (a subspecialty within the ear, nose and throat [ENT] department). For example, if laryngospasms are linked to GERD, then treating chronic acid reflux can also reduce your risk for laryngospasm. Advertising on our site helps support our mission. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. Simulation-based Training Scenario Laryngospasm during Induction of General Anesthesia in a 10-month-old Boy. Accessed Nov. 5, 2021. These are usually rare events and recurrence is uncommon, but if it happens, try to relax. information highlighted below and resubmit the form. They are most likely located in the medullary neuronal network rather than in the brainstem.2223The higher center seems to regulate upper airway reflexes. Anesth Analg 2002; 94:4949, Reber A, Bobbi SA, Hammer J, Frei FJ: Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children. Sometimes, laryngospasm happens for seemingly no reason. A single copy of these materials may be reprinted for noncommercial personal use only. 5 of 7 This document is not intended to provide a comprehensiv e discussion of each drug. We also use third-party cookies that help us analyze and understand how you use this website. Anesthesia was induced by a resident under the direct supervision of a senior anesthesiologist with inhaled sevoflurane in a 50/50% (5 l/min) mixture of oxygen and nitrous oxide. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. Case Scenario Perianesthetic Management of Laryngospasm In; Hazard Identification and Risk Assessment; Permit to Work Ensuring a Safe Work Environment Introduction Industrial Workers Face Many Hazards in Their Daily Routines; Health Surveillance Employer's Pack; Incidence and Associated Factors of Laryngospasm Among Pediatric #mergeRow-gdpr fieldset label { Vocal cord dysfunction. It is bounded anteriorly by the ascending ramus of the mandible adjacent to the condyle, posteriorly by the mastoid process of the temporal bone, and cephalad by the base of the skull.. URI = upper respiratory tract infection. A recent retrospective study has assessed the incidence of laryngospasm in a large population and characterized the interventions used to treat these episodes.8The results have shown that treatment followed a basic algorithm including CPAP, deepening of anesthesia, muscle relaxation, and tracheal intubation. Use of suxamethonium without intravenous access for severe laryngospasm. Med Educ 2010; 44:5063, Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ: Value of debriefing during simulated crisis management: Oral, Russo SG, Eich C, Barwing J, Nickel EA, Braun U, Graf BM, Timmermann A: Self-reported changes in attitude and behavior after attending a simulation-aided airway management course. People with laryngospasm are unable to speak or breathe. font: 14px Helvetica, Arial, sans-serif; Muscle relaxants are usually administered when initial steps of laryngospasm treatment have failed to relax the vocal cords. Without quick recognition and proper treatment, the patient's airway may occlude, leading to respiratory arrest followed by cardiac arrest. Broaddus VC, et al. Paediatr Anaesth 2008; 18:28996, Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO: Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients. Paediatr Anaesth 2005; 15:10947, Nawfal M, Baraka A: Propofol for relief of extubation laryngospasm. Used with permission of John Wiley and Sons. Qual Saf Health Care. Advertising revenue supports our not-for-profit mission. Cleveland Clinic is a non-profit academic medical center. This scenario illustrates the potential risks of not managing your resources properly. Two min after loss of eyelash reflex, a first episode of airway obstruction with inspiratory stridor and suprasternal retraction was successfully managed by jaw thrust and manual positive pressure ventilation. The onset of a vocal cord spasm is sudden, and just as suddenly, it goes away, usually after . Am J Med 2001; 111(Suppl 8A):69S77S, Shannon R, Baekey DM, Morris KF, Lindsey BG: Brainstem respiratory networks and cough. Br J Anaesth 2009; 103:5669, Wong AK: Full scale computer simulators in anesthesia training and evaluation. The first step of laryngospasm management is prevention. ,5emergent procedures had a moderately higher risk than elective procedures for perioperative respiratory adverse events, including laryngospasm (17%vs. Unfortunately, laryngospasms usually happen quickly. Immediately after extubation, the patient developed inspiratory stridor consistent with laryngospasm; the anesthesiologist had difficulty in mask ventilating the patient, and peripheral oxygen saturation decreased to less than 80%. The use of desflurane during maintenance of anesthesia appeared to be associated with a significant increase in perioperative respiratory adverse events, including laryngospasm, compared with sevoflurane and isoflurane.5Isoflurane appeared to produce laryngeal effects similar to sevoflurane.5. Recognizing laryngospasm - laryngospasm can occur spontaneously and be life-threatening, making it important that you be able to recognize it immediately. Past medical history was unremarkable except for an episode of upper respiratory tract infection 4 weeks ago. Insufficient depth of anesthesia is one of the major causes of laryngospasm. , otolaryngology surgery).2,5,,7Many factors may increase the risk of laryngospasm. #mergeRow-gdpr { According to Phil Larson: This notch is behind the lobule of the pinna of each ear. Jun 2005;14(3):e3. Can J Anaesth 2004; 51:45564, Goldmann K, Ferson DZ: Education and training in airway management. A new episode of laryngospasm was immediately suspected. 21,22. . This situation has been found to occur in approximately 50% of patients.8The most commonly used muscle relaxant is succinylcholine, but other agents have also been used, including rocuronium and mivacurium.8However, succinylcholine remains the gold standard.4Some authors have suggested the use of a small dose of succinylcholine (0.1 mg/kg) but there is a lack of dose-response study because the study included only three patients.52Therefore, we recommend using IV doses of succinylcholine no less than 0.5 mg/kg. It should be noted that hypoxia ultimately relaxes the vocal cords and permits positive pressure ventilation to proceed easily. ANESTHESIOLOGY 1998; 89:12934, Reber A, Paganoni R, Frei FJ: Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children. He created the Critically Ill Airway course and teaches on numerous courses around the world. Anesth Analg 1985; 64:11936, Lee CK, Chien TJ, Hsu JC, Yang CY, Hsiao JM, Huang YR, Chang CL: The effect of acupuncture on the incidence of postextubation laryngospasm in children. Lancet 2010; 376:77383, Murat I, Constant I, Maud'huy H: Perioperative anaesthetic morbidity in children: A database of 24,165 anaesthetics over a 30-month period. Anesth Analg 1978; 57:5067, Schebesta K, Gloglu E, Chiari A, Mayer N, Kimberger O: Topical lidocaine reduces the risk of perioperative airway complications in children with upper respiratory tract infections. #mc_embed_signup { } Learn more about the symptoms here. , partial or complete) and of the bradycardia as well as the existence of contraindication to succinylcholine. During high-fidelity simulation, technical and nontechnical skills can then be integrated and practiced. The onset of a vocal cord spasm is sudden, and just as suddenly, it goes away, usually after a few minutes. Propofol depresses laryngeal reflexes33,48and is therefore widely used to treat laryngospasm in children.3,49A study has assessed the effectiveness of a small bolus dose of propofol (0.8 mg/kg) for treatment of laryngospasm when 100% O2with gentle positive pressure had failed.49In this study, propofol was administered if laryngospasm occurred after LMA removal and if it persisted with a decrease in SpO2to 85% despite 100% O2with gentle positive pressure ventilation.49The injection of propofol was able to relieve spasm in 76.9% of patients, whereas the remaining patients required administration of succinylcholine and tracheal intubation.49The success rate of propofol observed in this study is superior to the chest compression technique mentioned previously.
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