Intervention steps for treating laryngospasm in pediatric patients

Background: Laryngospasm, a potentially life-threatening complication of anesthesia, is reported more commonly in children (17.4/1000) than in the general population (8.7/1000). However, there are no clinical data on the optimal type and sequence of therapeutic interventions. We therefore characterized the interventions used at St. Jude Children's Research Hospital. Methods: The institutional quality improvement database was reviewed to identify cases of laryngospasm that occurred from July 1999 through December 2002. Patient records were examined to determine the timing of laryngospasm, the airway management technique in use and the type of intervention used to treat the episode. Results: Twenty one cases of laryngospasm occurred (1/1000) during 21 452 anesthetics delivered in the operating room (19%) or for diagnostic and therapeutic procedures outside of the operating room (81%). Episodes occurred during emergence (47.6%), induction (28.6%) and maintenance (23.8%). Thirty-eight percent of patients responded to airway repositioning and continuous positive airway pressure. Ten patients (47.6%) were given muscle relaxants and five (23.8%) were intubated. Conclusions: In the largest single-institution study to date of laryngospasm in pediatric patients, we found a rate of 1/1000 cases. Treatment followed a basic algorithm comprising continuous positive airway pressure, deepening of anesthesia, muscle relaxation and tracheal intubation.