Laryngospasm in Paediatric Patients
Sep 18, 2023
Laryngospasm is an involuntary, protective reflex that causes closure of the vocal cords 🗣️
Without prompt treatment, it can result in profound hypoxia. It rarely happens in kids who are deeply anaesthetised or wide awake; it often happens in kids who are somewhere in between. (This is why it is common in the recovery room!) The incidence is dramatically increased between the ages of 1 and 5 years 👶
The effects of laryngospasm will not be seen in a patient who is intubated, as an endotracheal tube protects the patient from closure of the vocal cords. It will only affect a patient who has an LMA or no airway device at all. Laryngospasm is usually seen when there is some kind of stimulation (surgical pain, suction, movement, extubation or saliva/blood in the airway) in the setting of light anaesthesia.
You should suspect it is laryngospasm if you see the following:
👉🏽 Desaturation
👉🏽 Stridor or no upper airway sounds
👉🏽 No movement of air at the mouth
👉🏽 Breath holding OR “see saw” movement of the chest and abdomen
👉🏽 Not improved by positive pressure ventilation (PPV)
(Remember this could also be apnoea or upper airway obstruction, both of which will be improved by effective PPV using the circuit, a T piece or a self-inflating bag)
Management involves:
👉🏽 Remove the stimulus (pain, suction, poor fitting LMA), then
👉🏽 Apply the 6 P’s:
1️⃣Protect the IV
2️⃣Provide oxygen
3️⃣Position the patient (in an optimal position for airway management)
4️⃣Positive pressure (provide constant PEEP using circuit, T piece or self-inflating bag)
5️⃣Propofol* (to deepen the anaesthesia)
6️⃣Paralysis* (a small dose of suxamethonium to break the laryngospasm)
*This should be done in the presence of an anaesthetist, however, learning how to draw this up quickly is an excellent skill.
Now you know how to recognise and manage laryngospasm 👏 👏
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