Laryngospasm — Laryngospasm can occur during induction, maintenance, or

emergence from anesthesia, and most commonly occurs during light levels of anesthesia.
Laryngospasm must be recognized and treated rapidly to prevent complications. In most
cases, laryngospasm responds to treatment without sequelae, but oxygen desaturation,
bradycardia, negative pressure pulmonary edema, aspiration, and cardiac arrest can
occur.

Laryngospasm is the reflex closure of the false and true vocal cords, accompanied by the
descent of the epiglottis over the laryngeal orifice. Laryngospasm may progress from
inspiratory stridor, retractions, and rocking chest wall movement with inspiration, to
complete cessation of air movement despite inspiratory effort.

●Risk factors — The incidence of laryngospasm during anesthesia is higher in

children than in adults, and ranges from 1.7 to 25 percent [37,57,58]. Factors that
increase the risk of laryngospasm during anesthesia include the following:
•Airway instrumentation during light anesthesia
•Vocal cord irritation by inhalation anesthetics, secretions, mucus, or blood
•Young age, with infants at highest risk [37]
•Recent or current upper respiratory infection (URI) [59,60]
•Passive smoke exposure [61]
•Obstructive sleep apnea
•Airway anomaly
•Airway procedures (eg, tonsillectomy) [62]
●Prevention — Strategies that may be used to prevent laryngospasm during
induction of anesthesia include the following:
•Delay elective surgery for children with current or recent URI (See "Anesthesia
for the child with a recent upper respiratory infection", section on 'Timing of
elective procedures'.)
•Suction nasal and oropharyngeal secretions, if present
•Perform laryngoscopy, intubation, or insertion of SGA during deep plane of
anesthesia (ie, sevoflurane with or without propofol)
•Administer muscle relaxant for intubation
●Management — Treatment for laryngospasm should commence as soon as it is
recognized. Steps for management are described here and appear in an algorithm
(algorithm 1) [63].
•Administer 100 percent oxygen by face mask.
•Obtain tight mask seal, and deliver continuous positive airway pressure with jaw
thrust, neck extension, and mouth open. If necessary, place oral airway,
particularly if the nasal airway is obstructed (eg, by nasal secretions, adenoids,
anatomic factors).
•Deepen anesthesia, with sevoflurane or propofol.
•If no improvement, administer medications as follows:
Succinylcholine 0.25 to 0.5 mg/kg IV; if bradycardia
occurs, atropine 0.02 mg/kgIV, or succinylcholine 3 to 4 mg/kg IM; if bradycardia
occurs, atropine 0.02 mg/kgIM
Ventilate by mask, supraglottic airway, or endotracheal intubation until
neuromuscular block resolves.