Management of Laryngospasm
Immediate Initial Steps
- The American Society of Anesthesiologists recommends calling for help immediately upon recognizing laryngospasm to ensure additional experienced personnel are available 1, 2
- Apply continuous positive airway pressure (CPAP) with 100% oxygen using a reservoir bag and facemask while ensuring optimal head positioning (neck flexion with head extension) 1, 2
- Ensure adequate jaw thrust to maintain upper airway patency during CPAP application 1
Larson's Manoeuvre
- Place the middle finger of each hand in the "laryngospasm notch" located between the posterior border of the mandible and the mastoid process, and apply deep pressure at this point while simultaneously displacing the mandible forward in a jaw thrust maneuver 1, 2, 3
Pharmacological Management - Escalating Approach
- Administer propofol 1-2 mg/kg intravenously if laryngospasm persists 1, 2, 3, 4
- Administer suxamethonium 1 mg/kg intravenously immediately for continuing severe laryngospasm with total cord closure 1, 2, 3, 4, 5
Additional Considerations
- Ensure full neuromuscular blockade, and consider that inadequate muscle relaxation may be contributing if suxamethonium was used at induction and laryngospasm persists despite optimal airway maneuvers 6, 7
- Monitor for bradycardia, and atropine may be required to treat bradycardia that can occur with suxamethonium administration 1, 2, 3, 4
- In extremis, consider a surgical airway if all other measures fail 1, 2, 3
Critical Pitfalls to Avoid
- Complete laryngospasm presents with silent inspiration (no crowing sound), indicating total cord closure, and if unrelieved, laryngospasm can progress to post-obstructive pulmonary oedema, hypoxic cardiac arrest, and death 1, 2, 4, 5
- The younger the patient, the shorter the time to critical desaturation 9