Pediatric laryngospasm

Abstract

Pediatric laryngospasm is an anesthetic emergency. It is a relatively common phenomenon that occurs with varying frequency dependent on multiple factors. In view of this and the clear risks to the patient when it occurs, a consensus committee has been established to determine the evidence based management of this condition. This article will cover the definition, causes and recognition of laryngospasm and the evidence behind a proposed algorithm for its' management.

A Study of Postoperative Laryngospasm in Paediatric Age Group

“…These interventions include removal of irritant stimulant, chin lift, jaw thrust, positive pressure ventilation and sometimes CPAP with face mask. 2,3 Less commonly used airway manoeuvre like pressure in the "Laryngeal notch" and digital elevation of the tongue have also been practiced. 2,9,10 Recently, a new technique of gentle chest compression has been proposed as an alternative to standard practice for relief of laryngospasm.…”

“…who developed laryngospasm at the time of recovery from anaesthesia in the operation theatre were noted during that period. All these patients were managed by an Assistant Professor and a resident of Department of Anaesthesia by a set protocol as suggested by Hampson-Evans D et al 3 The protocol for the management of postoperative laryngospasm followed in our institution was as follows: {guidelines from Orliaguet et al 2 and D. Hampson-Evans et al 3 IV Hydrocortisone 2 mg/kg is given to all patients in step 1 [As an hospital protocol] in order to avoid laryngeal congestion and oedema during postoperative period. 4,5 Once respiratory rhythm is established sevoflurane is cut off and patient is kept on Hudson's mask with 40% O2 and monitored in postoperative ward.…”

Does magnesium sulfate affect the incidence of respiratory complications in children undergoing esophageal dilatation? An observational pilot study

“…(11) The frequency of laryngospasm caused by general anesthesia is increased in the pediatric population compared with adults. (12) Particularly when there is a risk of inadequate depth of anesthesia (i.e., the induction and emergence period), foreign bodies, such as secretions, laryngoscope, tube, and catheters, can irritate the vocal cords and cause laryngospasm. The incidence of laryngospasm may vary because of patient-related factors (e.g., upper respiratory infection, passive smoking, obesity, and reflux) or the type of operation being performed.…”

Anesthetizing children: little people, big problems!

“…Factors associated with laryngospasm include young age (infants), greater ASA physical status, upper respiratory tract infection, airway anomaly, passive smoking, foreign fluids / material in the airway and laryngeal mask airway (25). To prevent the development of laryngospasm or to stop it from progressing, it is important to review a management algorithm (26). A properly fitting facemask is essential.…”