Introduction
Laryngospasm involves the glottic closure as well as the cessation of ventilation even after the perseverance of respiratory measures. Out of all sedation-related adverse reactions, laryngospasm is the one that has the highest potential for grave complications. These serious complications include hypoxemia (low blood oxygen levels), aspiration, bradycardia (decreased heart rate), and cardiac arrest. The prevalence of laryngospasm, as well as the several risk factors of this adverse event, has been studied for several years under the specialty of general anesthesia but is yet quite less and not very well established for use during procedural sedation.
General anesthesia has always been associated with laryngospasm during airway manipulation, intubation, and extubation. The risk factors that have been investigated for laryngospasm amongst pediatric patients who are undergoing general anesthesia for medical purposes include intercurrent upper respiratory infection, active cases of asthma, presence of an airway disorder, airway and breathing procedures, being less than the age of three months, and also the use of a laryngeal mask airway system. Procedural sedation, on the contrary, may involve airway management through endotracheal intubation.
Laryngospasm during sedation is a crucial respiratory adverse reaction, and its rare occurrence provides a truly vast challenge for research. It is important to be aware and understand the patient, as well as the procedural risk factors along with the medication regimen that is associated with this risk so that it will be easier to predict which patients are at an increased risk of laryngospasm and vice-versa. The choice of using and selecting the safest and most effective sedation agent also gets more accurate.
What Are the Risk Factors of Laryngospasm During Pediatric Sedation?
The most heightened incidence of laryngospasm is generally found in most of the procedures involving surgery as well as the manipulations of the pharynx with the larynx. The epidemiology of laryngospasm post tracheal extubation in pediatric patients who have undergone tonsillectomy (removal of tonsils) is much higher as compared to pediatric patients who have not undergone such treatment. Urgent methods may additionally carry an increased risk of laryngospasm as against elective procedures.
Emergent procedures have a moderately higher risk potential than other elective procedures for perioperative respiratory adverse reactions, that include laryngospasm. There is an insufficient depth of anesthesia which can be understood as one of the most influential causes of laryngospasm. Mentioned below are a few of the risk factors of laryngospasm during pediatric sedation. These triggers may be common as well as extremely rare, depending on the patients.
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Any kind of stimulation in the area supplied by the nerve of the larynx, called the superior laryngeal nerve, during even a light plane of anesthesia, has the ability and potential to produce laryngospasm.
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Bodily secretions.
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Blood.
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Insertion of oropharyngeal airway suction catheter.
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Laryngoscopy.
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Inexperienced anesthetist.
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Perioperative respiratory adverse reactions.
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Intravenous induction.
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Airway management along with facemask.
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Inhalational maintenance of anesthesia.
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Induction and emergence from given anesthesia are the most critical periods.
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Newer inhalational agents.
These risk factors contribute to the development of laryngospasm during pediatric sedation. They may lead to complications that require further care and consideration. Laryngospasm occurs during anesthesia for mainly two reasons. A lack of inhibition of the glottic reflexes because of not applying a sufficient amount of central nervous system depression is the first reason. The second reason is an increased stimulus. Mentioned below are a few of the life-threatening complications of laryngospasm.
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Severe hypoxia.
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Bradycardia.
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Negative pressure pulmonary edema.
What Occurs in Laryngospasm During Pediatric Sedation?
The upper airway has several functions, such as swallowing, breathing, speaking, and phonation. The protection of the airway from any kind of foreign material remains one of the essential functions of laryngospasm. This function takes into action several upper airway reflexes, such as the laryngeal closure reflex consisting of the adduction of the vocal fold, apnea, swallowing, and even coughing. In order to efficiently protect this airway, the laryngeal closure reflex is coordinated along with swallowing. Both these reflexes are, at times, considered to be a single phylogenetic reflex. The neuronal pathways that underline the upper airway reflexes generally include an afferent pathway which can be understood to be a common central integration network, along with an efferent pathway.
What Are the Treatment and Prevention Methods of Laryngospasm in Pediatric Patients?
Laryngospasm is a standard intricacy during pediatric anesthesia. In the majority of cases, laryngospasm is usually self-limiting. Nonetheless, occasionally laryngospasm prevails, and if not suitably treated, it has the potential to result in profound complications that can end up being life-threatening to the patient.
Prevention: Recognizing the risk factors and bringing the essential protections are key in the prevention of laryngospasm. A professional anesthesiologist is linked with a lower incidence of laryngospasm. Airway management is the most fundamental part of the remedy of laryngospasm. Drugs can also be used as an adjunct in the treatment of laryngospasm when anesthesia is dispensed by novices.
Treatment: Currently, there is a huge lack of an internationally agreed algorithm for the management and treatment of pediatric laryngospasm. There is no single evidence of order to support an established protocol for the accurate management of laryngospasm. The majority of the evidence is only from small studies with a limited number of treatment groups and cases.
It is important to seek immediate medical attention if a laryngospasm episode occurs outside the operating room setting, particularly if the child's breathing is severely compromised or if the episode does not resolve with initial interventions. Consulting with a healthcare professional is essential to determine the appropriate course of treatment and prevention measures based on the child's individual needs and medical history.
Conclusion
Pediatric laryngospasm is an anesthetic emergency that must be attended to inside or even outside the operating room if necessary. Laryngospasm can be understood as glottic closure because of the reflex constriction of the laryngeal muscles. This closure can be complete or partial, and it is a relatively common phenomenon that takes place with different frequencies and is dependent on multiple reasons. Several protocols have to be adapted in order to understand the clear cause of laryngospasm so that it may provide a clear thought process to the healthcare professional even under a huge amount of stress.
