Laryngospasm Suspected
Signs of laryngeal obstruction during/after anesthesia
All Pathways
AnesthesiologyEmergency
Laryngospasm Management
Laryngospasm Management: Laryngospasm Suspected → Recognition of Laryngospasm → Call for Help → Initial Management - CPAP + Jaw Thrust → Spasm Relieved?.
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Recognition of Laryngospasm
Clinical signs
- Complete obstruction: silent (no air movement)
- Partial obstruction: inspiratory stridor, crowing
- Paradoxical chest/abdominal movement
- Tracheal tug, intercostal recession
- Desaturation (may be rapid)
- Common triggers: secretions, blood, light anesthesia, airway manipulation
03Action Call for Help
Get assistance immediately
- Alert OR team/nursing
- Call for senior anesthesia help
- Prepare emergency equipment
04Action Initial Management - CPAP + Jaw Thrust
First-line treatment
- 100% oxygen via tight-fitting face mask
- Apply firm CPAP (sustained positive pressure)
- Two-handed jaw thrust technique
- Suction oropharynx (remove stimulus)
- Insert oral airway if tolerated
- LARSON'S MANEUVER: firm pressure in 'laryngospasm notch'
- (behind ear lobe, anterior to mastoid, posterior to ascending ramus)
05Decision Spasm Relieved?
Assess response to CPAP and maneuvers
06Action Spasm Resolved - Stabilize
Post-spasm management
- Maintain oxygenation
- Suction secretions
- Observe for recurrence
- Deepen anesthesia if surgery ongoing
- Consider dexamethasone for airway edema
- Document incident thoroughly
07Action Post-Event Considerations
Monitoring and disposition
- Observe for negative pressure pulmonary edema (NPPE)
- Symptoms: pink frothy sputum, hypoxia, infiltrates
- CXR if concerned
- Extended PACU monitoring
- Consider ICU if NPPE or prolonged hypoxia
- Document and discuss with patient/family
08Outcome Airway Secured
Continue anesthetic/recovery care
09Decision Complete Obstruction / Desaturation?
SpO2 falling or no air entry
10Action Deepen Anesthesia
If spasm persists with partial obstruction
- Propofol 0.5-1 mg/kg IV (small boluses)
- Continue CPAP with O2
- May break spasm without paralysis
- Avoid large doses (apnea risk)
- Path rejoins step 05Shared downstream outcome
11Warning ⚠️ Succinylcholine
Muscle relaxation for refractory spasm
- IV ACCESS PRESENT:
- Succinylcholine 0.1-0.5 mg/kg IV
- (smaller dose may suffice)
- NO IV ACCESS:
- Succinylcholine 1-2 mg/kg IM (deltoid/tongue)
- Or 4 mg/kg IM (if rapid onset needed)
- PRETREAT with atropine 20 mcg/kg IV/IM if:
- - Child <10 years
- - Repeat dose of succinylcholine
- CONTRAINDICATIONS: hyperkalemia risk, MH history
12Action Secure Airway
Intubate after paralysis
- Bag-mask ventilate once relaxed
- Intubate to protect airway
- Suction trachea
- Confirm ETT placement
- May need repeat succinylcholine or NDMR
- Path rejoins step 06Shared downstream outcome
13Warning ⚠️ Bradycardia/Arrest Risk
Hypoxia-induced bradycardia
- Atropine 20 mcg/kg IV if HR dropping
- If cardiac arrest: Start CPR immediately
- Epinephrine per ACLS/PALS
- Hypoxia is the cause - fix airway!
- Path rejoins step 06Shared downstream outcome
Guideline Source
Crisis Management of Laryngospasm - WFSA/BJAED/Consensus
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Pediatric doses require weight-based calculation
- Succinylcholine contraindications must be considered
- Local protocols may vary
- Requires skilled airway management
Applicable Regions
USEUglobal
Global: Based on WFSA and international consensus
Version 1Next review: 2027-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Laryngospasm Management?
The Laryngospasm Management is a emergency clinical algorithm for Anesthesiology. It provides a structured decision tree to guide clinical decision-making, based on Crisis Management of Laryngospasm - WFSA/BJAED/Consensus.
What guideline is the Laryngospasm Management based on?
This algorithm is based on Crisis Management of Laryngospasm - WFSA/BJAED/Consensus (DOI: 10.1136/qshc.2002.004275).
What are the limitations of the Laryngospasm Management?
Known limitations include: Pediatric doses require weight-based calculation; Succinylcholine contraindications must be considered; Local protocols may vary; Requires skilled airway management. Individual patient factors may require deviation from these recommendations.
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