Laryngospasm Management

Introduction to Laryngospasm

The American Society of Anesthesiologists recommends immediate treatment of laryngospasm with continuous positive airway pressure (CPAP) and 100% oxygen, followed by propofol 1-2 mg/kg IV if it persists, and succinylcholine 1 mg/kg IV if there is progressive hypoxia, as this condition can rapidly progress to hypoxic cardiac arrest and death 1, 2

The American Academy of Pediatrics notes that laryngospasm is an exaggerated response to airway stimulation, and the main risk factors include children, with an incidence of 8.7/1000 patients, smokers, pre-existing respiratory infections, superficial anesthesia plane during airway manipulation, and airway procedures with increased secretions, blood, or surgical debris in the glottic area 1

The European Respiratory Society states that the precise pathophysiological mechanism of laryngospasm remains unclear, but the final outcome is persistent apposition of the vocal cords, with a clinical presentation that progresses from an initial inspiratory stridor or crowing sound, to partial obstruction with marked suprasternal retraction, use of accessory muscles, and paradoxical thoracoabdominal movements, and finally to complete obstruction with silent inspiration 1, 2

The American Heart Association recommends that if laryngospasm persists and oxygen saturation is falling, propofol 1-2 mg/kg IV should be administered, with a high level of evidence for this recommendation, and if hypoxia worsens despite propofol, succinylcholine 1 mg/kg IV should be given, with a moderate level of evidence 1, 2

The American Society of Anesthesiologists suggests that during extubation, applying oxygen at 100%, removing oropharyngeal secretions under direct vision with suction, inserting a bite block, positioning the patient appropriately, antagonizing residual neuromuscular blockade, and establishing regular breathing and adequate minute ventilation can help prevent laryngospasm, especially in patients with a history of previous episodes 3
The use of topical lidocaine applied to the vocal cords during induction can reduce the risk of laryngospasm in short procedures, and the use of less irritating anesthetic agents such as sevoflurane and propofol can also be beneficial 1

The American Academy of Emergency Medicine warns that delaying escalation of treatment can lead to rapid progression to complete airway obstruction and hypoxic cardiac arrest, with a high level of evidence for rapid intervention, and that unnecessary stimulation of the airway can worsen or prolong laryngospasm, with a moderate level of evidence 2