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Pediatric laryngospasm: prevention and treatment

Al-alami, Achir Ahmada; Zestos, Maria Markakisa; Baraka, Anis Shehatab

Current Opinion in Anesthesiology: June 2009 - Volume 22 - Issue 3 - p 388–395
doi: 10.1097/ACO.0b013e32832972f3
Pediatric anesthesia: Edited by Bernard J. Dalens

Purpose of review The purpose of this review is to discuss the risk factors associated with laryngospasm and the techniques used for prevention and treatment. We also summarize the prevention and treatment modalities in organized algorithms.

Recent findings According to recent endoscopic studies, laryngospasm is always complete, thus airway management and intravenous therapy are indicated. Parental history of children having upper respiratory infection is associated with increased risk of laryngospasm. Anesthesia administered by a pediatric anesthesiologist is associated with lower incidence of laryngospasm. Intravenous anesthesia is associated with lower incidence of laryngospasm than inhalational anesthesia. In tracheal intubation, the use of muscle relaxants decreases laryngospasm. Deep laryngeal mask airway removal is associated with lower incidence of laryngospasm in sevoflurane or isoflurane anesthesia. In no intravenous line situation, laryngospasm can be treated with succinylcholine administration by intramuscular, intraosseous and intralingual routes.

Summary Identifying the risk factors and taking the necessary precautions are the key points in prevention of laryngospasm. An experienced anesthesiologist is associated with lower incidence of laryngospasm. Airway management is the most essential part of treatment of laryngospasm. Drugs can be used as an adjunct in treatment of laryngospasm, especially when anesthesia is administered by beginners.

aChildren's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA

bAnesthesiology Department, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon

Correspondence to Achir Ahmad Al-alami, Fellow of Pediatric Anesthesiology, American University of Beirut Medical Center, Anesthesiology Department, Riad El-Solh, 11072020 Beirut, Lebanon Tel: +961 1 6202396; fax: +961 1 345325; e-mail: achiralami@gmail.com

© 2009 Lippincott Williams & Wilkins, Inc.