ANESTHESIOLOGY 1998; 88:114453, Leicht P, Wisborg T, Chraemmer-Jrgensen B: Does intravenous lidocaine prevent laryngospasm after extubation in children? Best Pract Res Clin Anaesthesiol 2005; 19:71732, McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ: A critical review of simulation-based medical education research: 20032009. Used with permission of John Wiley and Sons. Pulm Pharmacol Ther 2004; 17:37781, Suskind DL, Thompson DM, Gulati M, Huddleston P, Liu DC, Baroody FM: Improved infant swallowing after gastroesophageal reflux disease treatment: A function of improved laryngeal sensation? Med Educ 2010; 44:5063, Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ: Value of debriefing during simulated crisis management: Oral, Russo SG, Eich C, Barwing J, Nickel EA, Braun U, Graf BM, Timmermann A: Self-reported changes in attitude and behavior after attending a simulation-aided airway management course. health information, we will treat all of that information as protected health Anesth Analg 2007; 104:26570, Bordet F, Allaouchiche B, Lansiaux S, Combet S, Pouyau A, Taylor P, Bonnard C, Chassard D: Risk factors for airway complications during general anaesthesia in paediatric patients. Laryngospasm in anaesthesia | BJA Education | Oxford Academic Paediatr Anaesth 2003; 13:437, Schreiner MS, O'Hara I, Markakis DA, Politis GD: Do children who experience laryngospasm have an increased risk of upper respiratory tract infection? Thus, the potential window for safe administration of general anesthesia is frequently very short. Case scenario: perianesthetic management of laryngospasm in children The highest incidence of laryngospasm is found in procedures involving surgery and manipulations of the pharynx and larynx.2,5,,7The incidence of laryngospasm, after tracheal extubation, has already been reported to exceed 20% and be as high as 26.5% in pediatric patients who have undergone tonsillectomy.14,,17Urgent procedures also carry a higher risk of laryngospasm than elective procedures. Br J Anaesth 2001; 86:21722, Mark LC: Treatment of laryngospasm by digital elevation of tongue (letter). The locations of involved nerve receptors vary as a function of the upper airway reflex: pharyngeal mucosa for the swallowing reflex, supraglottic larynx for laryngeal closure reflex,19larynx and trachea for cough, and any part of the upper airway (but mainly nose and larynx) for apnea. Whereas epithelial damage heals in 12 weeks, virus-induced sensitization of bronchial autonomic efferent pathways can last for up to 68 weeks. PDF Postanesthesia Care Unit Simulation - WordPress.com In the study by von Ungern-Sternberg et al. Simulation-based Training Scenario Laryngospasm during Induction of General Anesthesia in a 10-month-old Boy. Exhale through pursed lips. The use of desflurane during maintenance of anesthesia appeared to be associated with a significant increase in perioperative respiratory adverse events, including laryngospasm, compared with sevoflurane and isoflurane.5Isoflurane appeared to produce laryngeal effects similar to sevoflurane.5. If the diagnosis is laryngospasm or other vocal cord dysfunction, your doctor may refer you to a speech-language pathologist to help you learn breathing exercises. During the exercise, the instructor can observe and measure the performance of the trainees and compare them with the standards of performance mentioned in the algorithms. SimBaby is a tetherless simulator designed to help healthcare providers effectively recognize and respond to critically ill pediatric patients. Recently, a new technique with gentle chest compression has been proposed as an alternative to standard practice for relief of laryngospasm.47In this before-after study, extubation laryngospasm was managed with standard practice (CPAP and gentle positive pressure ventilation via a tight-fitting facemask with 100% O2via facemask) during the first 2 yr of the study, whereas in the following 2 yr, laryngospasm was managed with 100% O2and concurrent gentle chest compression. There are data supporting the efficacy of structured courses that integrate airway trainers and high fidelity simulation for airway management training.7677Recent evidence also supports the transfer of technical and nontechnical skills acquired during simulation to the clinical setting.78We therefore strongly encourage the integration of simulation-based training for pediatric airway management, including for the management of laryngospasm. Upper respiratory tract infection (URI) is associated with a twofold to fivefold increase in the risk of laryngospasm.5,9Anesthesiologists in charge of pediatric patients should be aware that the risks associated with a URI in an infant are magnified in this age group, especially in those with respiratory syncytial virus infection.10Children with URI are prone to develop airway (upper and bronchial) hyperactivity that lasts beyond the period of viral infection. APPENDIX. His one great achievement is being the father of three amazing children. To confirm the diagnosis, your healthcare provider may look at your vocal cords with a laryngeal endoscope. Laryngospasm scenario. Anesthesiology. Epidemiology of Laryngospasm in Pediatric Patients Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children 1,000).2,5-7 In fact, the incidence of laryngospasm has been gery (i.e., otolaryngology surgery).2,5-7 Many factors may increase the risk of laryngospasm. He is a co-founder of theAustralia and New Zealand Clinician Educator Network(ANZCEN) and is the Lead for theANZCEN Clinician Educator Incubatorprogramme. The anesthesiologist assesses that the head/neck could be placed in a more ideal position . Br J Anaesth 1998; 81:6925, Krodel DJ, Bittner EA, Abdulnour R, Brown R, Eikermann M: Case scenario: Acute postoperative negative pressure pulmonary edema. This usually occurs because of stimulation during a light plane of anaesthesia but may also occur because of blood, secretions, and foreign bodies (e.g. Description. This situation has been found to occur in approximately 50% of patients.8The most commonly used muscle relaxant is succinylcholine, but other agents have also been used, including rocuronium and mivacurium.8However, succinylcholine remains the gold standard.4Some authors have suggested the use of a small dose of succinylcholine (0.1 mg/kg) but there is a lack of dose-response study because the study included only three patients.52Therefore, we recommend using IV doses of succinylcholine no less than 0.5 mg/kg. Muscle relaxants are usually administered when initial steps of laryngospasm treatment have failed to relax the vocal cords. As your vocal cords slowly relax and open, you may hear a high-pitched sound (stridor). Hobaika AB, Lorentz MN. Stimulation of upper airway mucosa also produces cardiovascular (alterations of the arterial pressure, bradycardia, etc.) Laryngospasm may be preceded by a high-pitched inspiratory stridor some describe a characteristic crowing noise followed by complete airway obstruction. Learning outcomes are difficult to measure. Anaesthesia 1983; 38:3935, Sibai AN, Yamout I: Nitroglycerin relieves laryngospasm. The efficacy of lidocaine to either prevent or control extubation laryngospasm has been studied since the late 1970s.62Some articles have confirmed the efficacy of lidocaine for preventing postextubation laryngospasm, whereas others have found the opposite results to be true.16,63,,65A recent, well-conducted, randomized placebo-controlled trial in children undergoing cleft palate surgery demonstrated the effectiveness of IV lidocaine (1.5 mg/kg administered 2 min after tracheal extubation) in reducing laryngospasm and coughing (by 29.9% and 18.92%, respectively).64However, these favorable results were not confirmed in other studies.5,65The role of lidocaine (IV or topical) in preventing laryngospasm is still controversial. Airway management training, including management of laryngospasm, is an area that can significantly benefit from the use of simulators and simulation.73These tools represent alternative nonclinical training modalities and offer many advantages: individuals and teams can acquire and hone their technical and nontechnical skills without exposing patients to unnecessary risks; training and teaching can be standardized, scheduled, and repeated at regular intervals; and trainees' performances can be evaluated by an instructor who can provide constructive feedback, a critical component of learning through simulation.7475. IV line insertion should also be delayed until deep anesthesia (regular ventilation with large tidal volume, eyeballs fixed with pupils centered in myosis or moderately dilated) is achieved. If you have recurring laryngospasms, schedule an appointment with a healthcare provider who specializes in laryngology (a subspecialty within the ear, nose and throat [ENT] department). The authors also thank Frank Schneider (Editing Coordinator, Division of Communication and Marketing of the Geneva University Hospitals, Geneva University Hospitals) and Justine Giliberto (Editing, Division of Communication and Marketing of the Geneva University Hospitals) for editing the video material. These are the reasons why inhalational induction conducted by nonspecialized anesthetists remains associated with an increased risk of laryngospasm.2,5,18In children with hyperactive airways, there are now several arguments in favor of IV induction with propofol versus inhalational induction. Case Scenario Perianesthetic Management of Laryngospasm In Laryngospasms are rare and typically last for fewer than 60 seconds. But it can be a symptom of other conditions, including: Left untreated, laryngospasm caused by anesthesia can be fatal. Qual Saf Health Care. ANESTHESIOLOGY 1996; 85:47580, Nishino T: Physiological and pathophysiological implications of upper airway reflexes in humans. ANESTHESIOLOGY 2010; 12:98592, McGaghie WC: Medical education research as translational science. Sci Transl Med 2010; 2:19cm8. Anesth Analg 2002; 94:4949, Reber A, Bobbi SA, Hammer J, Frei FJ: Effect of airway opening manoeuvres on thoraco-abdominal asynchrony in anaesthetized children. These risk factors can be Broaddus VC, et al. Laryngospasm can sometimes occur after an endotracheal tube is removed from the throat. But opting out of some of these cookies may have an effect on your browsing experience. The cause of vocal cord spasms is often unknown, and it is usually in response to a trigger such as anxiety or acid reflux. ANESTHESIOLOGY 1997; 87:136872, Mazurek AJ, Rae B, Hann S, Kim JI, Castro B, Cot CJ: Rocuronium, Cheng CA, Aun CS, Gin T: Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children. PDF pan 2446 303. - McGill University #mergeRow-gdpr { Relative Risk (95% CI) of Laryngospasm in Children According to the Presence of Cold Symptoms, Household exposure to tobacco smoke was shown to increase the incidence of laryngospasm from 0.9% to 9.4% in children scheduled for otolaryngology and urologic surgery.12This strong association between passive exposure to tobacco smoke and airway complications in children was also observed in another large study.13. Keech BM, et al. Fig. Laryngospasm is potentially life-threatening closure of the true vocal chords resulting in partial or complete airway obstruction unresponsive to airway positioning maneuvers. c. Treatment of laryngospasm is aimed at supporting ventilation. A single copy of these materials may be reprinted for noncommercial personal use only. Pediatr Emerg Care 1990; 6:1089, Woolf RL, Crawford MW, Choo SM: Dose-response of rocuronium bromide in children anesthetized with propofol: A comparison with succinylcholine. GERD: Can certain medications make it worse? anaesthesia: laryngospasm. Extubation guidelines: management of laryngospasm ANESTHESIOLOGY 2007; 107:7149, Tait AR, Burke C, Voepel-Lewis T, Chiravuri D, Wagner D, Malviya S: Glycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis.3,5,7In both partial and complete laryngospasm, signs of varying degrees of airway obstruction, such as suprasternal retraction, supraclavicular retractions, tracheal tug, paradoxical chest, and abdominal movements may be seen.3In addition, inspiratory stridor may be heard in partial laryngospasm but is absent in complete spasm. Second-level studies attempt to document the transfer of skills to the clinical setting and patient care. 5 Many high-acuity medical conditions can induce these. Laryngospasm (luh-RING-go-spaz-um) is a transient and reversible spasm of the vocal cords that temporarily makes it difficult to speak or breathe. ANESTHESIOLOGY 2006; 105:4550, Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber A: The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children. Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection? Laryngospasm is identied by varying degrees of airway obstruction with paradoxical chest move-ment, intercostal recession and tracheal tug. Larson CP Jr. Laryngospasmthe best treatment. Airway simulators and high fidelity mannequins are important teaching tools.73Simple bench models, airway mannequins, and virtual reality simulators can be used to learn and practice basic and complex technical skills. If IV access cannot be established in emergency, succinylcholine may be given by an alternative route.5354Intramuscular succinylcholine has been recommended at doses ranging from 1.5 to 4 mg/kg.53The main drawback of intramuscular administration is the slow onset in comparison with the IV route. Prevention of laryngospasm. 14%, relative risk 1.2, 95% CI 1.11.3; P= 0.001). Can J Anaesth 2010; 57:74550, Sanikop C, Bhat S: Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries. Unfortunately, laryngospasms usually happen quickly. Refer to each drug's package In: Anesthesia Secrets. , partial or complete) and of the bradycardia as well as the existence of contraindication to succinylcholine. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis. More needed than oxygen! There is a need to fill this knowledge gap and to answer questions about what types of clinical education and what type of management algorithm result in better outcome. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. The . The diagnosis of laryngospasm is made and treated, only to reveal persistent hypoxemia and negative-pressure pulmonary edema (NPPE). Anesth Analg 1978; 57:5067, Schebesta K, Gloglu E, Chiari A, Mayer N, Kimberger O: Topical lidocaine reduces the risk of perioperative airway complications in children with upper respiratory tract infections. However, if youve experienced laryngospasms in the past, your healthcare provider can determine whats causing them and find ways to reduce your risk. . "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Adults may be less prone to development of laryngospasm. It should be noted that hypoxia ultimately relaxes the vocal cords and permits positive pressure ventilation to proceed easily. For children with URI, cancellation of elective procedures for a period of 46 weeks was traditionally the rule. Manual facemask ventilation became difficult with an increased resistance to insufflation and SpO2dropped rapidly from 98% to 78%, associated with a decrease in heart rate from 115 to 65 beats/min. Paediatr Anaesth 2008; 18:3037. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. TeamSTEPPS Instructor Manual: Specialty Scenarios We also use third-party cookies that help us analyze and understand how you use this website. If breathing exercises and pushing on your laryngospasm notch dont relieve your symptoms, call 911 or head to the nearest emergency room. Furthermore, the efficacy of propofol to break complete laryngospasm when bradycardia is present has been questioned.4In our case, two bolus doses of 5 mg IV propofol (each representing a dose of 0.6 mg/kg) were administered but did not relieve airway obstruction. Advertising on our site helps support our mission. Nasal foreign body, ketamine and laryngospasm, Clinical Adjunct Associate Professor at Monash University, Australia and New Zealand Clinician Educator Network, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Call for help early. The afferent nerve involved in laryngeal closure reflex is the superior laryngeal nerve. Although described in the conscious state and associated with silent reflux, laryngospasm is a problematic reflex which occurs often under general anaesthesia. ANESTHESIOLOGY 1963; 24:585, Al-Metwalli RR, Mowafi HA, Ismail SA: Gentle chest compression relieves extubation laryngospasm in children. He is retaining oxygen saturations > 94 percent. In children with URI, the use of an endotracheal tube (ETT) may increase by 11-fold the risk of respiratory adverse events, in comparison with a facemask.11Less invasive airway management could be beneficial in children with airway hyperactivity. Target Audience: Laryngospasm: Causes, Symptoms, and Treatments - WebMD There is controversy in the literature regarding the use of inhalational or IV induction agents and associated risk of laryngospasm. The next line of therapy would be to administer a low dose of succinylcholine (10Y20 mg) to relax the . Elsevier; 2022. https://www.clinicalkey.com. , gastric acid).24They (mechanical and chemical stimuli) are favored by local inflammation with subsequent alteration of pharyngolaryngeal sensation (URI, gastroesophageal reflux disease, neurologic disorders)20,2526; and factors influencing the central regulation system of upper airway reflexes, such as age.2021, After stimulation of the superior laryngeal nerve, apnea may result from several mechanisms: prolonged laryngeal closure reflex-related laryngeal obstruction (see the previously mentioned risk factors for increased laryngeal closure reflex); decreased swallowing reflex with accumulation of secretions in contact with the larynx vestibule and subsequent laryngeal closure reflex;21,27and centrally controlled apneic reflex possibly related to the diving reflex observed in aquatic mammals and aimed at preventing fluid aspiration in the lower airway. Singapore Med J 1998; 39:32830, Warner DO: Intramuscular succinylcholine and laryngospasm. The patient will then develop worsened hypotension, requiring the start of an epinephrine infusion. In fact, when the inspiratory stridulous noise was noted again, the patient was receiving 2% end-tidal sevoflurane and 50% N2O, representing barely 1 minimum alveolar concentration in an infant. During high-fidelity simulation, technical and nontechnical skills can then be integrated and practiced. Attempt airway maneuvers such as jaw thrust and nasal airway. According to Phil Larson: This notch is behind the lobule of the pinna of each ear. These preliminary results are interesting and need to be confirmed by further studies. PubMed PMID. #mergeRow-gdpr fieldset label { People with laryngospasm are unable to speak or breathe. Laryngospasm in amyotrophic lateral sclerosis. In: Murray and Nadel's Textbook of Respiratory Medicine. Whether or not this is relevant to perioperative risk of laryngospasm has been questioned many times in the literature.9,11Von Ungern-Sternberg et al. Learn how your comment data is processed. He is also a Clinical Adjunct Associate Professor at Monash University. ANESTHESIOLOGY 2001; 95:103940, Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL: Dose response to intramuscular succinylcholine in children. Causes: hypocalcemia, painful stimuli . 21,22. . The final decision depends on the severity of the laryngospasm (i.e. [Laryngospasm]. If you are a Mayo Clinic patient, this could ANESTHESIOLOGY 1981; 55:599602, Walker RW, Sutton RS: Which port in a storm? Laryngospasm (luh-RING-o-spaz-um) is a condition in which your vocal cords suddenly spasm (involuntarily contract or seize). Drowning is an international public health problem that has been complicated by . Accessed Nov. 5, 2021. font-weight: normal; Paediatr Anaesth 2005; 15:10947, Nawfal M, Baraka A: Propofol for relief of extubation laryngospasm. Description The patient requires intubation, but isn't actively crashing. retained throat pack). Anesth Analg 1991; 73:26670, Rachel Homer J, Elwood T, Peterson D, Rampersad S: Risk factors for adverse events in children with colds emerging from anesthesia: A logistic regression. Last reviewed by a Cleveland Clinic medical professional on 02/11/2022. In this case, some equipment has high usage demands and becomes scarce throughout the unit. It is most commonly occurring on induction or emergence phases and can have serious life threatening consequences. Although third-level studies may prove very difficult or subject to bias, first- and second-level studies are feasible but have yet to be performed for laryngospasm and pediatric airway training. The treatment includes opening and clearing the oropharynx, applying CPAP with 100% oxygen, followed by deepening of anaesthesia usually with an i.v . These results are in accordance with a study showing that subhypnotic doses of propofol (0.5 mg/kg) decreased the likelihood of laryngospasm upon tracheal extubation in children undergoing tonsillectomy with or without adenoidectomy.50Lower doses of propofol (0.25 mg/kg) have also been used successfully to relax the larynx in a small series.51It should be noted that few data are available regarding the use of propofol to treat laryngospasm in younger age groups (younger than 3 yr). The authors thank Frances O'Donovan, M.D., F.F.A.R.C.S.I. font: 14px Helvetica, Arial, sans-serif; The patient is unconscious and initially breathing easily with an oral airway in place. Learn more about the symptoms here. Example Plan for a neonate! Adapted from Hampson-Evans D, Morgan P, Farrar M: Pediatric laryngospasm. Afferent nerves converge in the brainstem nucleus tractus solitarius. Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children (17.4/1,000) than in the general population (8.7/1,000).2,5,,7In fact, the incidence of laryngospasm has been found to range from 1/1,000 up to 20/100 in high-risk surgery (i.e. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. In a more recent series, the overall incidence of laryngospasm was lower8but the predominance of such incidents at a young age was still clear: 50 to 68% of cases occurred in children younger than 5 yr. Experimental evidences and anecdotal reports indicate that intraosseous and IV injection behave similarly, resulting in adequate intubating conditions within 45 s (1 mg/kg).57In children in whom succinylcholine is contraindicated, rocuronium administered at a dose of two to three times the ED95(0.9 to 1.2 mg/kg) may represent a reasonable substitute when rapid onset is needed.58,,60In addition, there is a possibility to quickly reverse the neuromuscular blockade induced by rocuronium using sugammadex if necessary.61. can occur spontaneously, most commonly associated with extubation or ENT procedures CAUSES Local extubation especially children with URTI symptoms Laryngospasm may not be obvious it may present as increased work of breathing (e.g. Also find out about . The first step of laryngospasm management is prevention. Identifying patients at increased risk for laryngospasm and taking recommended precautions are the most important measures to prevent laryngospasm (fig. , at the condyles of the ascending rami of the mandible, then its efficacy would be improved. can occur spontaneously, most commonly associated with extubation or ENT procedures, extubation especially children with URTI symptoms, intubation and airway manipulation (especially if insufficiently sedated), drugs e.g. The breathing difficulty can be alarming, but it's not life-threatening. Paediatr Anaesth 2002; 12:1405, Plaud B, Meretoja O, Hofmockel R, Raft J, Stoddart PA, van Kuijk JH, Hermens Y, Mirakhur RK: Reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. Avoid breathing in through your nose. It is frequently observed in fetuses and newborns, whereas later on, laryngeal closure reflex and cough become predominant.21This developmental pattern may be implicated in sudden infant death. This content does not have an English version. Taking an antacid or acid inhibitor for a few weeks may help diagnose the problem by the process of elimination. include protected health information. More specifically, laryngeal closure reflex involves the laryngeal intrinsic muscles responsible for vocal folds adduction, i.e. He is on the Board of Directors for theIntensive Care Foundationand is a First Part Examiner for theCollege of Intensive Care Medicine. Laryngospasm: Treatment, Definition, Symptoms & Causes - Cleveland Clinic Some people may experience recurring (returning) laryngospasms. demonstrated that in children age 26 yr, laryngeal and respiratory reflex responses differed between sevoflurane and propofol at similar depths of anesthesia, with apnea and laryngospasm being less severe with propofol.33If tracheal intubation is planned, the use of muscle relaxants prevents the risk of laryngospasm.2In contrast, topical anesthesia is probably not effective and the incidence of laryngospasm is even higher when vocal cords are sprayed with aerosolized lidocaine.5, Laryngospasm is commonly caused by systemic painful stimulation if the anesthesia is too light during maintenance. Anesth Analg 1996; 82:7247, Skolnick ET, Vomvolakis MA, Buck KA, Mannino SF, Sun LS: Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. Accessed Nov. 5, 2021. A recent retrospective study has assessed the incidence of laryngospasm in a large population and characterized the interventions used to treat these episodes.8The results have shown that treatment followed a basic algorithm including CPAP, deepening of anesthesia, muscle relaxation, and tracheal intubation. The video and the script are intended to illustrate the proper application of the management algorithm, to illustrate the technical and the nontechnical skills required in clinical practice, and to be a resource for the readers who wish to develop their own training sessions. Muscles involved: lateral cricoarytenoid, thyroarytenoids (both from recurrent laryngeal), crycrothyroid (from external branch of superior laryngeal). Int J Pediatr Otorhinolaryngol 2010; 74:4868, Al-alami AA, Zestos MM, Baraka AS: Pediatric laryngospasm: Prevention and treatment. information and will only use or disclose that information as set forth in our notice of Shortness of breath. Anaesthesia 2007; 62:7579, Tobias JD, Nichols DG: Intraosseous succinylcholine for orotracheal intubation. If you have any of the conditions listed above, talk to your healthcare provider about ways to reduce your risk for laryngospasms. You might experience multiple laryngospasms in a brief time but in most cases, each episode ends after about a minute.
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