Laryngospasm

INTRODUCTION

Pediatric laryngospasm is the closure of the glottis caused by reflex tightening of the laryngeal muscles, leading to either partial or complete obstruction of the larynx. In a classic report, two types of laryngospasm was described: expiratory stridor, which is an active closure of the glottis secondary to adductor spasm and inspiratory stridor, which is a passive closure of the glottis secondary to a ball–valve mechanism. This condition can escalate to an anesthetic emergency when it is complete and sustained, typically occurring during the induction, maintenance, and emergence phases of general anesthesia. Symptoms of laryngospasm often include inspiratory stridor, which can progress to complete airway obstruction, increased breathing effort, tracheal tug, paradoxical breathing effort, oxygen desaturation, bradycardia, and unresponsive airway obstruction even with a Guedel airway.

INCIDENCE AND STATISTICAL DATA

The incidence of laryngospasm varies across studies, with higher occurrences in pediatric patients compared to adults. Reported rates are 0.87% in adults, 1.7% in pediatrics, and 2.82% in infants. Older children have a doubly higher incidence than adults, while younger children have a threefold higher incidence. Statistics Laryngospasm causes about 40% of postextubation airway obstruction and the incidence of complications resulting from laryngospasm can vary as follows: cardiac arrest (0.5%), obstructive negative pressure pulmonary edema (4%), pulmonary aspiration (3%), bradycardia (6%) and oxygen desaturation (61%).

RISK FATORS

Risk factors for laryngospasm can be categorized into patient-related, surgery-related, and anesthesia-related factors;

Anesthesia-related risk factors include inadequate depth of anesthesia, which can lead to laryngospasm when stimulating events occur. Factors such as pain, movement of the cervical spine, placement of nasogastric tubes, and irritation of the vocal cords by various substances can trigger laryngospasm. Additionally, the use of muscle relaxants during tracheal intubation can lower the risk of laryngospasm. It has been observed that intravenous anesthesia is associated with a lower incidence of laryngospasm compared to inhalational anesthesia.

The experience level of the anesthesiologist also plays a significant role in the occurrence of laryngospasm, with higher incidence rates reported with less experienced practitioners.

Patient-related risk factors include young age, upper respiratory infections, asthma, passive smoking, and certain medical conditions like obstructive sleep apnea and gastroesophageal reflux disease;

Surgery-related factors that increase the risk of laryngospasm include airway procedures, tonsillectomy and adenoidectomy surgeries, appendicectomy, hypospadias repair, and esophageal endoscopy.

PREVENTION

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Relevant Article Depot:

Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review

Pediatric laryngospasm

Pediatric laryngospasm: prevention and treatment

Review of laryngospasm and noncardiogenic pulmonary edema

Laryngospasm: review of different prevention and treatment modalities

Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation

Gentle chest compression relieves extubation laryngospasm in children

Relief of laryngospasm with gentle chest compressions during direct laryngotracheobronchoscopy