Algorithm to Diagnose and Manage Laryngospasm in Children Algorithm to Diagnose and Manage Laryngospasm in Children

Flowchart

Recognize laryngospasm Recognize laryngospasm Apply CPAP with 100% O₂
and airway maneuvers Apply CPAP with 100% O₂
and airway maneuvers ₂
Assess O₂ entry
bag movement None None Some Some Assess O₂ entry
bag movement ₂
None None None None Some Some Some Some None None COMPLETE
LARYNGOSPASM COMPLETE
LARYNGOSPASM
Consider specialized
maneuvers to convert
to partial laryngospasm Consider specialized
maneuvers to convert
to partial laryngospasm

NO IMPROVEMENT No IV access No IV access IV access IV access NO IMPROVEMENT No IV access No IV access No IV access No IV access IV access IV access IV access IV access No IV access No IV access Suxamethonium IM
3–4 mg/kg
atropine IM
0.02 mg/kg
and call for help Suxamethonium IM
3–4 mg/kg
atropine IM
0.02 mg/kg
and call for help



CPAPVentilate with 100% O₂
attempt intubation as appropriate No improvement No improvement Improvement Improvement CPAPVentilate with 100% O₂
attempt intubation as appropriate ₂
No improvement No improvement No improvement No improvement Improvement Improvement Improvement Improvement No improvement No improvement CPR + ALS
as indicated CPR + ALS
as indicated
Improvement Improvement Stabilize and resume
anesthetic and ?NG tube Stabilize and resume
anesthetic and ?NG tube
IV access IV access Suxamethonium IV
1–2 mg/kg
atropine I.V.
0.02 mg/kg
(or consider I.V. propofol) Suxamethonium IV
1–2 mg/kg
atropine I.V.
0.02 mg/kg
(or consider I.V. propofol)



Some Some PARTIAL
LARYNGOSPASM PARTIAL
LARYNGOSPASM
Eliminate stimulus
Deepen anesthesia
with volatile or propofol Eliminate stimulus
Deepen anesthesia
with volatile or propofol

Reassess O₂ entry with
CPAP NO IMPROVEMENT NO IMPROVEMENT IMPROVEMENT IMPROVEMENT Reassess O₂ entry with
CPAP ₂
NO IMPROVEMENT NO IMPROVEMENT NO IMPROVEMENT NO IMPROVEMENT IMPROVEMENT IMPROVEMENT IMPROVEMENT IMPROVEMENT IMPROVEMENT IMPROVEMENT IV access IV access No IV access No IV access IV access IV access IV access IV access No IV access No IV access No IV access No IV access