The procedure was expected to be very short, and general anesthesia with inhalational induction and maintenance, but without tracheal intubation, was planned. Anesth Analg 2007; 104:26570, Bordet F, Allaouchiche B, Lansiaux S, Combet S, Pouyau A, Taylor P, Bonnard C, Chassard D: Risk factors for airway complications during general anaesthesia in paediatric patients. A single copy of these materials may be reprinted for noncommercial personal use only. Effective management of laryngospasm in children requires appropriate diagnosis,4followed by prompt and aggressive management.8Many authors recommend applying airway manipulation first, beginning with removal of the irritant stimulus38and then administering pharmacologic agents if necessary.8. Learn more about the symptoms here. Identifying the risk factors and planning appropriate anesthetic management is a rational approach to reduce laryngospasm incidence and severity. Acta Anaesthesiol Scand 2009; 53:19, Larson CP Jr: Laryngospasmthe best treatment. Postanesthesia Care Unit Simulation: Acute Upper Airway Obst - LWW Rutt AL, et al. Causes: hypocalcemia, painful stimuli . Exhale through pursed lips. 2012 Feb;116(2):458-71. doi: 10.1097/ALN.0b013e318242aae9. Paediatr Anaesth 2002; 12:7629, Tait AR, Pandit UA, Voepel-Lewis T, Munro HM, Malviya S: Use of the laryngeal mask airway in children with upper respiratory tract infections: A comparison with endotracheal intubation. The next line of therapy would be to administer a low dose of succinylcholine (10Y20 mg) to relax the . For example, you might be able to exhale and cough, but have difficulty breathing in. Discover the causes, such as anesthesia and gastroesophageal reflux disease (GERD). Upper respiratory tract infection (URI) is associated with a twofold to fivefold increase in the risk of laryngospasm.5,9Anesthesiologists in charge of pediatric patients should be aware that the risks associated with a URI in an infant are magnified in this age group, especially in those with respiratory syncytial virus infection.10Children with URI are prone to develop airway (upper and bronchial) hyperactivity that lasts beyond the period of viral infection. Place a straw in your mouth and seal your lips around it. It is still debated whether tracheal extubation should be performed in awake or deeply anesthetized children to decrease laryngospasm. Many describe a choking sensation. Although third-level studies may prove very difficult or subject to bias, first- and second-level studies are feasible but have yet to be performed for laryngospasm and pediatric airway training. Alterations of upper airway reflexes may occur in several conditions. Designing a Simulation Scenario - StatPearls - NCBI Bookshelf During observation, she exhibits a sudden increase in respiratory effort and noise with ventilation. privacy practices. Relative Risk (95% CI) of Laryngospasm in Children According to the Presence of Cold Symptoms, Household exposure to tobacco smoke was shown to increase the incidence of laryngospasm from 0.9% to 9.4% in children scheduled for otolaryngology and urologic surgery.12This strong association between passive exposure to tobacco smoke and airway complications in children was also observed in another large study.13. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Laryngospasm: Treatment, Definition, Symptoms & Causes - Cleveland Clinic If the cause is unclear, your doctor may refer you to an ear, nose and throat specialist (otolaryngologist) to look at your vocal cords with a mirror or small fiberscope to be sure there is no other abnormality. have demonstrated an increased risk for laryngospasm only when cold symptoms were present on the day of surgery or less than 2 weeks before.28This finding was recently confirmed by the same team in an extensive study involving 9,297 surgical procedures.5Rescheduling patient 23 weeks after an URI episode appears to be a safe approach. In most cases, a laryngospasm lasts for up to one minute, but it may feel much longer. Laryngospasm. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. The onset of a vocal cord spasm is sudden, and just as suddenly, it goes away, usually after . Prospective studies supported the use of LMA over ETT in children with URI.3031However, these studies were underpowered to detect differences in laryngospasm. TeamSTEPPS 2.0 Specialty Scenarios - 85 Specialty Scenarios OR Scenario 68 Appropriate for: All Specialties . ANESTHESIOLOGY 2001; 95:299306, Lakshmipathy N, Bokesch PM, Cowen DE, Lisman SR, Schmid CH: Environmental tobacco smoke: A risk factor for pediatric laryngospasm. Usually, laryngospasm resolves and the patient recovers quickly without any sequelae. In contrast, results from studies in children with recent URIs have shown that LMA was associated with an increased occurrence of laryngospasm.28,32In a recent, large, prospective study, the incidence of laryngospasm was increased after direct stimulation of the upper airway by both LMA and ETT in comparison with a facemask.5Therefore, LMA may be considered more stimulating than the facemask but certainly less than the ETT. Table 1. Mayo Clinic. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. Description. But opting out of some of these cookies may have an effect on your browsing experience. There is a need to fill this knowledge gap and to answer questions about what types of clinical education and what type of management algorithm result in better outcome. border: none; URI = upper respiratory tract infection. Therefore, the injection of IV succinylcholine was required to treat this persistent laryngospasm. , the overall incidence of respiratory adverse events seems to be higher in children who were awake when their LMA was removed and lower in those who were awake when their endotracheal tube was removed.5In summary, evidence seems to favor deep LMA and awake ETT removal. Definition. It is a primitive protective airway reflex that exists to . Laryngospasm: Stimulation of vagus nerve during light anesthesia (Superior Laryngeal n, pharyngeal br of vagus, recurrent laryngeal below cords). Hold your breath for five seconds, then repeat until the laryngospasm stops. Anesth Analg 1991; 73:26670, Rachel Homer J, Elwood T, Peterson D, Rampersad S: Risk factors for adverse events in children with colds emerging from anesthesia: A logistic regression. Copyright 2012, the American Society of Anesthesiologists, Inc. Perianesthetic Management of Laryngospasm in Children, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0b013e318242aae9, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Perianesthetic Dental Injuries : Frequency, Outcomes, and Risk Factors, Understanding the Mechanics of Laryngospasm Is Crucial for Proper Treatment, Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane. Even though laryngospasm isnt usually serious or life-threatening, the experience can be terrifying. Ann Otol Rhinol Laryngol 2005; 114:25863, Thach BT: Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life. Pediatr Emerg Care 1990; 6:1089, Woolf RL, Crawford MW, Choo SM: Dose-response of rocuronium bromide in children anesthetized with propofol: A comparison with succinylcholine. Table 2. Case Scenario: - American Society of Anesthesiologists Description The patient requires intubation, but isn't actively crashing. Understanding the mechanics of laryngospasm is crucial for proper treatment. Paediatr Anaesth 2005; 15:10947, Nawfal M, Baraka A: Propofol for relief of extubation laryngospasm. other information we have about you. Pediatr Pulmonol 2010; 45:4949, Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal RS: Is there a role of a small dose of propofol in the treatment of laryngeal spasm? The SimBaby simulator represents a 9-month-old pediatric patient and provides a highly realistic manikin that meets specific learning objectives focusing on initial assessment and treatment. No chest wall movement with no breath sounds on auscultation, Inability to manually ventilate with bag-mask ventilation, ischemic end organ injury (e.g. Minimally invasive anti-reflux procedures, Advertising and sponsorship opportunities. If you think youve experienced laryngospasm, talk to your healthcare provider. Can J Anaesth 2004; 51:45564, Goldmann K, Ferson DZ: Education and training in airway management. Sufficient depth of anesthesia must be achieved before direct airway stimulation is initiated (oropharyngeal airway insertion). Laryngospasm is one of the many critical situations that any anesthesiologist should be able to manage efficiently. So when in doubt, meticulous observation with aggressive preparation may be reasonable. Plan A:" 3.5 ETT ready, size 1 Macintosh laryngoscope blade" Small orange Bougie (pre bent), have a size 1 Miller blade available" Have a shoulder roll ready, but I wont put it in place" Have a white guedel airway available if I am having difculty with ventilation" If that doesnt work I will do the 2 person technique" There are data supporting the efficacy of structured courses that integrate airway trainers and high fidelity simulation for airway management training.7677Recent evidence also supports the transfer of technical and nontechnical skills acquired during simulation to the clinical setting.78We therefore strongly encourage the integration of simulation-based training for pediatric airway management, including for the management of laryngospasm. the unsubscribe link in the e-mail. Search for other works by this author on: Bhananker SM, Ramamoorthy C, Geiduschek JM, Posner KL, Domino KB, Haberkern CM, Campos JS, Morray JP: Anesthesia-related cardiac arrest in children: Update from the Pediatric Perioperative Cardiac Arrest Registry. include protected health information. The apneic reflex varies as a function of age. It is not the same as choking. Experimental evidences and anecdotal reports indicate that intraosseous and IV injection behave similarly, resulting in adequate intubating conditions within 45 s (1 mg/kg).57In children in whom succinylcholine is contraindicated, rocuronium administered at a dose of two to three times the ED95(0.9 to 1.2 mg/kg) may represent a reasonable substitute when rapid onset is needed.58,,60In addition, there is a possibility to quickly reverse the neuromuscular blockade induced by rocuronium using sugammadex if necessary.61. Anaphylaxis (+/- Laryngospasm) A 7-year-old male presents with wheeze, rash and increased WOB after eating a birthday cake. He created the Critically Ill Airway course and teaches on numerous courses around the world. But it can be a symptom of other conditions, including: Left untreated, laryngospasm caused by anesthesia can be fatal. Von Ungern-Sternberg et al. However, if youve experienced laryngospasms in the past, your healthcare provider can determine whats causing them and find ways to reduce your risk. This topic is beyond the scope of this article but was recently described elsewhere.37Eighty percent of negative pressure pulmonary edema cases occur within min after relief of the upper airway obstruction, but delayed onset is possible with cases reported up to 46 h later. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Inexperience of the anesthetist is also associated with an increased incidence of laryngospasm and perioperative respiratory adverse events.2,5,18Some factors are associated with a lower risk of laryngospasm: IV induction, airway management with facemask, and inhalational maintenance of anesthesia.5Induction and emergence from anesthesia are the most critical periods. In case of sale of your personal information, you may opt out by using the link. Qual Saf Health Care 2005; 14:e3, Fernandez E, Williams DG: Training and the European Working Time Directive: A 7 year review of paediatric anaesthetic trainee caseload data. Here are some important features to keep in mind: Complete blockage may present as just apnea; Can be preceded by high-pitched inspiratory stridor, followed by complete airway obstruction J Pediatr 1985; 106:6259, Nishino T, Isono S, Tanaka A, Ishikawa T: Laryngeal inputs in defensive airway reflexes in humans. health information, we will treat all of that information as protected health Paediatr Anaesth 2004; 14:15866, Olsson GL, Hallen B: Laryngospasm during anaesthesia. Risk Factors Associated with Perioperative Laryngospasm, Young age is one of the most important risk factors. Chris is an Intensivist and ECMO specialist at theAlfred ICU in Melbourne. information and will only use or disclose that information as set forth in our notice of The progressive signs and symptoms are shivering (36C), confusion, disorientation, introversion (35C), amnesia (34C), cardiac arrhythmias (33C), clouding of consciousness (33-30C), LOC (30C), ventricular fibrillation (VF) (28C), and death (25C). These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. If you or someone youre with is having a laryngospasm, you should: In addition to the techniques outlined above, there are breathing exercises that can help you through a laryngospasm. Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Am J Med 2001; 111(Suppl 8A):69S77S, Shannon R, Baekey DM, Morris KF, Lindsey BG: Brainstem respiratory networks and cough. Part A - Laryngospasm case study Introduction Laryngospasm is a medical emergency that can happen to any patient undergoing anaesthesia. Adults may be less prone to development of laryngospasm. Laryngospasm may not be obvious it may present as increased work of breathing (e.g. Airway management training, including management of laryngospasm, is an area that can significantly benefit from the use of simulators and simulation.73These tools represent alternative nonclinical training modalities and offer many advantages: individuals and teams can acquire and hone their technical and nontechnical skills without exposing patients to unnecessary risks; training and teaching can be standardized, scheduled, and repeated at regular intervals; and trainees' performances can be evaluated by an instructor who can provide constructive feedback, a critical component of learning through simulation.7475. Laryngoscope 2006; 116:1397403, Nishino T, Hasegawa R, Ide T, Isono S: Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. Laryngospasm is the sustained closure of the vocal cords resulting in the partial or complete loss of the patient's airway. As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. Laryngospasms are rare and typically last for fewer than 60 seconds. ANESTHESIOLOGY 2001; 95:103940, Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL: Dose response to intramuscular succinylcholine in children. Fig. Elsevier; 2021. https://www.clinicalkey.com. More specifically, laryngeal closure reflex involves the laryngeal intrinsic muscles responsible for vocal folds adduction, i.e. Manipulation of the airway at an insufficient depth of anesthesia is a major cause of laryngospasm. A simulation scenario is an artificial representation of a real-world event to achieve educational goals through experiential learning. If you are a Mayo Clinic patient, this could First-level studies evaluate the effect of training in a controlled environment (in simulation). Thus, the potential window for safe administration of general anesthesia is frequently very short. GillesA. Orliaguet, Olivier Gall, GeorgesL. Savoldelli, Vincent Couloigner, Bruno Riou; Case Scenario: Perianesthetic Management of Laryngospasm in Children. Mayo Clinic does not endorse any of the third party products and services advertised. Suxamethonium injection in a hypoxic patient may lead to severe bradycardia and even to cardiac arrest. He is one of the founders of theFOAMmovement (Free Open-Access Medical education) and is co-creator oflitfl.com,theRAGE podcast, theResuscitologycourse, and theSMACCconference. Laryngospasm was treated by 50 mg propofol and manual positive pressure mask ventilation with 100% inspired oxygen. If breathing exercises and pushing on your laryngospasm notch dont relieve your symptoms, call 911 or head to the nearest emergency room. Our providers specialize in head and neck surgery and oncology; facial plastic and reconstructive surgery; comprehensive otolaryngology; laryngology; otology, neurotology and lateral skull base disorders; pediatric otolaryngology; rhinology, sinus and skull base surgery; surgical sleep; dentistry and oral and maxillofacial surgery; and allied hearing, speech and balance services. Eur Respir J 2001; 17:123943, Holm-Knudsen RJ, Rasmussen LS: Paediatric airway management: Basic aspects. We do not endorse non-Cleveland Clinic products or services. The . This rare phenomenon is often a symptom of an underlying condition. (Staff Anesthesiologist, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland), and Jos-Manuel Garcia (Technical Coordinator, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals) for their contribution in the video of the simulated scenario. Training . Based on a work athttps://litfl.com. Paediatr Anaesth 2008; 18:2818, Hampson-Evans D, Morgan P, Farrar M: Pediatric laryngospasm. If the diagnosis is laryngospasm or other vocal cord dysfunction, your doctor may refer you to a speech-language pathologist to help you learn breathing exercises. This function involves several upper airway reflexes: the laryngeal closure reflex, which consists of vocal fold adduction; apnea; swallowing; and coughing.19To efficiently protect the airway, laryngeal closure reflex must be coordinated with swallowing. Complete airway obstruction is characterized by: Where is the laryngospasm notch? background: #fff; Accessed Nov. 5, 2021. Laryngospasm usually isnt life-threatening, but it can be a terrifying experience. Laryngospasm is an emergency situation and must be promptly recognized. Anesth Analg 1998; 86:70611, Flick RP, Wilder RT, Pieper SF, van Koeverden K, Ellison KM, Marienau ME, Hanson AC, Schroeder DR, Sprung J: Risk factors for laryngospasm in children during general anesthesia. If complete laryngospasm cannot be rapidly relieved, IV agents should be quickly considered. Paediatr Anaesth 2007; 17:15461, Guglielminotti J, Constant I, Murat I: Evaluation of routine tracheal extubation in children: Inflating or suctioning technique? Elsevier; 2022. https://www.clinicalkey.com. Classification and Types of Submersion Injuries and Drowning Scenarios. These are usually rare events and recurrence is uncommon, but if it happens, try to relax. Common triggers of reflex laryngeal response during anesthesia are secretions, blood, insertion of an oropharyngeal airway suction catheter, and laryngoscopy. TeamSTEPPS Instructor Manual: Specialty Scenarios information submitted for this request. There is controversy in the literature regarding the use of inhalational or IV induction agents and associated risk of laryngospasm. It is mandatory to procure user consent prior to running these cookies on your website. Such a conservative attitude has already been proposed for otolaryngology patients, whose surgery is expected to have an effect on the recurrence of URI episodes.11Premedication with anticholinergic agents may decrease secretions but has no demonstrated influence on the incidence of laryngospasm.7,29. Laryngospasm (luh-RING-go-spaz-um) is a transient and reversible spasm of the vocal cords that temporarily makes it difficult to speak or breathe. ANESTHESIOLOGY 1996; 85:47580, Nishino T: Physiological and pathophysiological implications of upper airway reflexes in humans. acute dystonic reactions; rarely associated with ketamine procedural sedation. Best Pract Res Clin Anaesthesiol 2005; 19:71732, McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ: A critical review of simulation-based medical education research: 20032009. Experimentally, Oberer et al. Despite a jaw thrust maneuver, positive pressure ventilation with 100% O2, and administration of two bolus doses (5 mg) of IV propofol (0.6 mg/kg), the obstruction was not relieved and SpO2decreased to 52%. To avoid significant morbidity and mortality, the use of a structured algorithm has been proposed.8,70One study suggests that if correctly applied, a combined core algorithm recommended for the diagnosis and management of laryngospasm would have led to earlier recognition and/or better management in 16% of the cases.70These results should encourage physicians to implement their own structured algorithm for the diagnosis and management of laryngospasm in children in their institutions. For the management of laryngospasm in children, this task is complicated by two facts. PubMed PMID: 19669024. However, children younger than 3 yr may develop 510 URI episodes per year. During the exercise, the instructor can observe and measure the performance of the trainees and compare them with the standards of performance mentioned in the algorithms. 1998 Nov;89(5):1293-4. PERIOPERATIVE laryngospasm is an anesthetic emergency that is still responsible for significant morbidity and mortality in pediatric patients.1It is a relatively frequent complication that occurs with varying frequency dependent on multiple factors.2,,5Once the diagnosis has been made, the main goals are identifying and removing the offending stimulus, applying airway maneuvers to open the airway, and administering anesthetic agents if the obstruction is not relieved. ANESTHESIOLOGY 1998; 89:12934, Reber A, Paganoni R, Frei FJ: Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children. It is most commonly occurring on induction or emergence phases and can have serious life threatening consequences. It should be noted that hypoxia ultimately relaxes the vocal cords and permits positive pressure ventilation to proceed easily. Pulm Pharmacol 1996; 9:3437, Shannon R, Baekey DM, Morris KF, Lindsey BG: Ventrolateral medullary respiratory network and a model of cough motor pattern generation. Singapore Med J 1998; 39:32830, Warner DO: Intramuscular succinylcholine and laryngospasm. Symptoms can be mild or severe. Whereas epithelial damage heals in 12 weeks, virus-induced sensitization of bronchial autonomic efferent pathways can last for up to 68 weeks. 1. , gastric acid).24They (mechanical and chemical stimuli) are favored by local inflammation with subsequent alteration of pharyngolaryngeal sensation (URI, gastroesophageal reflux disease, neurologic disorders)20,2526; and factors influencing the central regulation system of upper airway reflexes, such as age.2021, After stimulation of the superior laryngeal nerve, apnea may result from several mechanisms: prolonged laryngeal closure reflex-related laryngeal obstruction (see the previously mentioned risk factors for increased laryngeal closure reflex); decreased swallowing reflex with accumulation of secretions in contact with the larynx vestibule and subsequent laryngeal closure reflex;21,27and centrally controlled apneic reflex possibly related to the diving reflex observed in aquatic mammals and aimed at preventing fluid aspiration in the lower airway. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis.3,5,7In both partial and complete laryngospasm, signs of varying degrees of airway obstruction, such as suprasternal retraction, supraclavicular retractions, tracheal tug, paradoxical chest, and abdominal movements may be seen.3In addition, inspiratory stridor may be heard in partial laryngospasm but is absent in complete spasm. Advertising revenue supports our not-for-profit mission. They are most likely located in the medullary neuronal network rather than in the brainstem.2223The higher center seems to regulate upper airway reflexes. Indian J Anaesth 2010; 54:1326, Behzadi M, Hajimohamadi F, Alagha AE, Abouzari M, Rashidi A: Endotracheal tube cuff lidocaine is not superior to intravenous lidocaine in short pediatric surgeries. ANESTHESIOLOGY 1981; 55:599602, Walker RW, Sutton RS: Which port in a storm? Review. But if you have laryngospasms often, you should schedule an appointment with your healthcare provider. Insufficient depth of anesthesia is one of the major causes of laryngospasm. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361892/). These cookies do not store any personal information. OVERVIEW Laryngospasm is potentially life-threatening closure of the true vocal chords resulting in partial or complete airway obstruction unresponsive to airway positioning maneuvers. Rev Bras Anestesiol. width: auto; However, the acquisition and the mastering of these skills during specialty training and their maintenance during continuing medical education represent a formidable challenge. The cause of vocal cord spasms is often unknown, and it is usually in response to a trigger such as anxiety or acid reflux. For children with URI, cancellation of elective procedures for a period of 46 weeks was traditionally the rule. In: Anesthesia Secrets. . Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis. have demonstrated an increased risk for laryngospasm only when cold symptoms are present the day of surgery or less than 2 weeks before (table 2).5Therefore, for children who present for elective procedures with a temperature higher than 38C, mucopurulent airway secretions, or lower respiratory tract signs such as wheezing and moist cough, surgery is usually postponed. Laryngospasms can be frightening, whether youve experienced them before or not. If you have any of the conditions listed above, talk to your healthcare provider about ways to reduce your risk for laryngospasms. If this happens to you, talk to your healthcare provider. From: Encyclopedia of . A computer-aided incidence study in 136,929 patients Acta Anaesthesiol Scand 1984; 28:56775, Burgoyne LL, Anghelescu DL: Intervention steps for treating laryngospasm in pediatric patients. These interventions include removal of the irritant stimulus,8,38chin lift, jaw thrust,39continuous positive airway pressure (CPAP), and positive pressure ventilation with a facemask and 100% O2.3,40,,43These maneuvers are popular because they have been shown to improve the patency of the upper airway in case of airway obstruction.42,4445Less commonly used airway maneuvers, such as pressure in the laryngospasm notch4,44and digital elevation of the tongue46also have been proposed as rapid and effective methods.8Overall conflicting results have been obtained regarding the best maneuver to relieve airway obstruction in children with laryngospasm. For instance, coughing can be voluntarily inhibited. | INTENSIVE | RAGE | Resuscitology | SMACC. and bronchomotor reflexes, indicating that not only skeletal but also smooth muscles are involved in upper airway reflexes.19. ANESTHESIOLOGY 2010; 113:2007, Roy WL, Lerman J: Laryngospasm in paediatric anaesthesia. Treatment of laryngospasm. In fact, when the inspiratory stridulous noise was noted again, the patient was receiving 2% end-tidal sevoflurane and 50% N2O, representing barely 1 minimum alveolar concentration in an infant.
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