Basic, Clinical Sciences: Anesthesia Procedures, Methods, and Techniques
Laryngospasm is a relatively common complication of general anesthesia, occurring at much higher frequency in children as compared to adults. Up to 2% of children less than the age of 1 year may suffer laryngospasm during general anesthesia. Treatment generally follows a stepwise approach starting with airway manipulation, then progressing to pharmacologic treatment to deepen the anesthetic depth, and finally muscle relaxant.
The first step in management of laryngospasm is typically airway manipulation with jaw thrust and the application of 15-20cm H20 CPAP with 100% oxygen. Application of gentle positive pressure ventilation can be attempted, but aggressive PPV should be avoided in order to decrease the risk of gastric insufflation and aspiration. Pressure can also be applied to the so-called “laryngospasm notch” between the condyle of the mandible and the mastoid process during jaw thrust. If these maneuvers are not successful then the patient is likely to be in complete laryngospasm and will require more aggressive treatment.
If airway manipulation has failed the next step in treatment should be to deepen the anesthetic with 0.5mg/kg of propofol administered IV. This is often successful (>70% of the time according to some sources) and avoids the side effects associated with succinylcholine. If deepening of the anesthetic does not relieve laryngospasm, succinylcholine should be administered promptly. If IV access is available, 1-2 mg/kg succinylcholine should be administered. Due to the possibility of concomitant bradycardia, some providers may prophylactically give atropine 0.02mg/kg IM or IV along with succinylcholine. If IV access is not available succinylcholine can be administered IM at a dose of 4-5mg/kg.