Anaes Cases · Paediatric anaesthesia
Laryngospasm progressing to bradycardia in a 3-year-old
The canonical paediatric hot case: laryngospasm escalating to complete obstruction and bradycardia, testing recognition, the Larson manoeuvre, pharmacological escalation, and the post-event assessment for negative-pressure pulmonary oedema.
On this page
Study tools
Target exams
ANZCAFRCAEDAICABAFCAI
Prompt
A 3-year-old undergoing myringotomy develops inspiratory stridor thirty seconds after induction with sevoflurane, followed within a minute by silent obstruction and a heart rate falling to 50. The anaesthetist cannot ventilate. Manage.
Assessment
The diagnosis is laryngospasm progressing to complete glottic closure with reflex bradycardia from hypoxaemia. The pattern — inspiratory stridor at a light plane, then silent obstruction, then bradycardia — is the classical sequence, and in a child the cycle from desaturation to bradycardia to arrest can complete in under three minutes. This is the canonical paediatric airway emergency.[3]
References3ShowHide
- [1]Flick RP, Wilder RT, Pieper SF, et al. Risk factors for laryngospasm in children during general anesthesia. Paediatric Anaesthesia, 2008.PMID 18315633
- [2]Mihara T, Uchimoto K, Morita S, Goto T The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis. Anaesthesia, 2014.PMID 24992191
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.