Laryngospasm

Reflex closure of the vocal cords from light-anesthesia airway stimulation. Common in pediatrics, recent URI, and emergence. Untreated → hypoxia → bradycardia → arrest.

Recognition

•Inspiratory stridor (partial) → silent chest with paradoxical movement (complete)
•Rising PIP with no CO₂ trace
•Desaturation despite bagging
•Common during light anesthesia: induction, emergence, secretions

Steps

1
100% FiO₂, remove noxious stimulus
Stop suctioning, surgical stim; suction blood/secretions away from cords.
2
Larson's maneuver + jaw thrust
Bilateral firm pressure at the styloid notch (behind the earlobe). Often breaks the spasm.
3
CPAP 15–20 cm H₂O with tight mask seal
4
Deepen anesthesia
Propofol 0.5–1 mg/kg IV breaks light-plane spasm.
5
Succinylcholine 0.1–0.5 mg/kg IV (or 2–4 mg/kg IM if no IV)
IM works through the deltoid in 60–90 sec.
6
Atropine 0.02 mg/kg IV in pediatrics
Prevents reflex bradycardia from sux + hypoxia.
7
Re-intubate + suction + secure if recurrent

Drugs + doses

Drug	Dose	Note
Propofol	0.5–1 mg/kg IV
Succinylcholine	0.1–0.5 mg/kg IV; 2–4 mg/kg IM
Atropine	0.02 mg/kg IV (peds; min 0.1 mg)

Pitfalls

!Forced positive pressure with poor seal pushes O₂ into the stomach, not lungs.
!Do NOT give sux to a cold induction in suspected MH-susceptible patient.
!Re-extubate deep, not light, in patients with reactive airways.

Sources

AANA Practice Considerations: Airway
Hampson-Evans Paediatr Anaesth 2008

Anatomy reference

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Education only — not a substitute for facility protocols, MOC certification, or clinical judgment. Always follow your institutional crisis algorithm and confirm doses against current package inserts.