Symptoms can be mild or severe. Acta Anaesthesiol Scand 2009; 53:19, Larson CP Jr: Laryngospasmthe best treatment. This category only includes cookies that ensures basic functionalities and security features of the website. Am J Med 2001; 111(Suppl 8A):69S77S, Shannon R, Baekey DM, Morris KF, Lindsey BG: Brainstem respiratory networks and cough. They are most likely located in the medullary neuronal network rather than in the brainstem.2223The higher center seems to regulate upper airway reflexes. , at the condyles of the ascending rami of the mandible, then its efficacy would be improved. Mayo Clinic. Drowning is an international public health problem that has been complicated by . Only sevoflurane or halothane should be used for inhalational induction. The diagnosis of laryngospasm is made and treated, only to reveal persistent hypoxemia and negative-pressure pulmonary edema (NPPE). It is mandatory to procure user consent prior to running these cookies on your website. It persists for a longer period in the context of respiratory syncytial virus infection, hypoxia, and anemia.21, The diagnosis of laryngospasm depends on the clinical judgment of the anesthesiologist. Laryngospasm is potentially life-threatening closure of the true vocal chords resulting in partial or complete airway obstruction unresponsive to airway positioning maneuvers. If you or someone youre with is having a laryngospasm, you should: In addition to the techniques outlined above, there are breathing exercises that can help you through a laryngospasm. Otolaryngol Head Neck Surg 1998; 118:8802, Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO: The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: A preliminary study. J Anesth 2010; 24:8547, Schroeck H, Fecho K, Abode K, Bailey A: Vocal cord function and bispectral index in pediatric bronchoscopy patients emerging from propofol anesthesia. This site uses Akismet to reduce spam. URI = upper respiratory tract infection. 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). But if you have laryngospasms often, you should schedule an appointment with your healthcare provider. Common presenting signs and symptoms include tachypnea, tachycardia, diaphoresis, trembling, palpitations, shortness of breath and chest pain. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. Treatment of laryngospasm. Laryngospasm is a sudden spasm of the vocal cords. 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. During observation, she exhibits a sudden increase in respiratory effort and noise with ventilation. Laryngospasm can sometimes occur after an endotracheal tube is removed from the throat. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. As they correctly point out, laryngospasm is a serious complication and must be promptly managed to avoid serious physiological disturbance. Even though you may feel like you cant breathe, try to remember that the episode will pass. 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. For children with URI, cancellation of elective procedures for a period of 46 weeks was traditionally the rule. (https://pubmed.ncbi.nlm.nih.gov/34817079/), Visitation, mask requirements and COVID-19 information, chronic obstructive pulmonary disease (COPD). As your vocal cords slowly relax and open, you may hear a high-pitched sound (stridor). In the study by von Ungern-Sternberg et al. Both reflexes are sometimes considered as a single phylogenetic reflex.20The neuronal pathways underlying upper airway reflexes include an afferent pathway, a common central integration network, and an efferent pathway.19. An IV line was obtained at 11:15 PM, while the child was manually ventilated. Laryngospasm can happen suddenly and without warning, lasting up to one minute. can occur spontaneously, most commonly associated with extubation or ENT procedures CAUSES Local extubation especially children with URTI symptoms Br J Anaesth 2001; 86:21722, Mark LC: Treatment of laryngospasm by digital elevation of tongue (letter). Jpn J Physiol 2000; 50:314, Thompson DM, Rutter MJ, Rudolph CD, Willging JP, Cotton RT: Altered laryngeal sensation: A potential cause of apnea of infancy. The afferent nerve involved in laryngeal closure reflex is the superior laryngeal nerve. 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. 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. A characteristic crowing noise may be heard in partial laryngospasm but will be absent in complete laryn-gospasm. It is a primitive protective airway reflex that exists to . There is a problem with Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Anesth Analg 1998; 86:70611, Flick RP, Wilder RT, Pieper SF, van Koeverden K, Ellison KM, Marienau ME, Hanson AC, Schroeder DR, Sprung J: Risk factors for laryngospasm in children during general anesthesia. Advertising on our site helps support our mission. 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). 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? In: Murray and Nadel's Textbook of Respiratory Medicine. Two min after loss of eyelash reflex, a first episode of airway obstruction with inspiratory stridor and suprasternal retraction was successfully managed by jaw thrust and manual positive pressure ventilation. 1. The brainstem nucleus tractus solitarius is not only an afferent portal, but has interneurons that play an essential role in the genesis of upper airway reflexes.19Little is known about the centers that regulate and program these reflexes. 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. have demonstrated an increased risk for laryngospasm only when cold symptoms were present on the day of surgery or less than 2 weeks before.28This finding was recently confirmed by the same team in an extensive study involving 9,297 surgical procedures.5Rescheduling patient 23 weeks after an URI episode appears to be a safe approach. Principal effectors are respiratory muscles (diaphragm, intercostals, abdominals, and upper airway). Some advocate delivery of jaw thrust and CPAP as the first airway opening maneuvers to improve breathing patterns in children with airway obstruction.42For others, both chin lift and jaw thrust maneuvers combined with CPAP improve the view of the glottic opening and decrease stridor in anesthetized, spontaneously breathing children.41It is likely that if the jaw thrust maneuver is properly applied, i.e. The mother volunteered that he was exposed to passive smoking in the home. Anesthesia was then maintained by facemask with 2.0% expired sevoflurane in a mixture of oxygen and nitrous oxide 50/50%. If the cause is unclear, your doctor may refer you to an ear, nose and throat specialist (otolaryngologist) to look at your vocal cords with a mirror or small fiberscope to be sure there is no other abnormality. For instance, coughing can be voluntarily inhibited. c. Treatment of laryngospasm is aimed at supporting ventilation. Laryngospasm is an emergency situation and must be promptly recognized. 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. information and will only use or disclose that information as set forth in our notice of Several studies suggest that deep extubation reduces this incidence, whereas others observed no difference.5,3435In one study, tracheal intubation with deep extubation was associated with increased respiratory adverse events rate (odds ratio = 2.39) compared with LMA removal at a deep level of anesthesia, whereas use of a facemask alone decreased respiratory adverse events (odds ratio = 0.15).35The difference between LMA and ETT was less evident when awake extubation was used (odds ratio = 0.65 and 1.26, respectively). Laryngospasm is a rare but frightening experience. Example Plan for a neonate! (Staff Anesthesiologist, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland), and Jos-Manuel Garcia (Technical Coordinator, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals) for their contribution in the video of the simulated scenario. Click here for an email preview. The onset of a vocal cord spasm is sudden, and just as suddenly, it goes away, usually after a few minutes. Identifying patients at increased risk for laryngospasm and taking recommended precautions are the most important measures to prevent laryngospasm (fig. His one great achievement is being the father of three amazing children. It is not the same as choking. #mergeRow-gdpr fieldset label { Alterations of upper airway reflexes may occur in several conditions. ANESTHESIOLOGY 2005; 103:11428, Patel RI, Hannallah RS, Norden J, Casey WF, Verghese ST: Emergence airway complications in children: A comparison of tracheal extubation in awake and deeply anesthetized patients. Anesthesiology. Taking an antacid or acid inhibitor for a few weeks may help diagnose the problem by the process of elimination. If you think youve experienced laryngospasm, talk to your healthcare provider. The purpose of this case scenario is to highlight key points essential for the prevention, diagnosis, and treatment of laryngospasm occurring during anesthesia. 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. These are usually rare events and recurrence is uncommon, but if it happens, try to relax. 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. Learn how your comment data is processed. A simulation scenario is an artificial representation of a real-world event to achieve educational goals through experiential learning. More specifically, laryngeal closure reflex involves the laryngeal intrinsic muscles responsible for vocal folds adduction, i.e. Understanding the mechanics of laryngospasm is crucial for proper treatment. Realistic training with high-fidelity mannequins and other types of simulations represent unique educational tools that can be fully integrated in a residency program based on competency.72Similarly, simulation-based education is being increasingly used for continuing medical education. 1. It occurs during general or local anesthesia, natural sleep (rapid eye movement phase of sleep), hypercapnia, and hypoxia, as well as various muscular, neuromuscular junction, or peripheral nerves disorders affecting the efferent neural pathway and effector organs of upper airway reflexes.19, This condition arises as a result of an exaggerated and prolonged laryngeal closure reflex that can be triggered by mechanical (manipulation of pharynx or larynx) or chemical stimuli (e.g. Here are some important features to keep in mind: Complete blockage may present as just apnea; Can be preceded by high-pitched inspiratory stridor, followed by complete airway obstruction 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. He coordinates the Alfred ICUs education and simulation programmes and runs the units educationwebsite,INTENSIVE. Breathe in and out through the straw without pausing between the inhale and the exhale. Unfortunately, laryngospasms usually happen quickly. Breathe in slowly through your nose. This content does not have an English version. The purpose of this case scenario is to highlight keypoints essential for the prevention, diagnosis, and treatmentof laryngospasm occurring during anesthesia. Among all upper airway reflexes, it is the most resistant to deepening anesthesia, whereas the coughing reflex is the most sensitive. A 10-month-old boy (8.5 kg body weight) was taken to the operating room (at 11:00 PM), without premedication, for emergency surgery of an abscess of the second fingertip on the right hand. We decided to omit it in the preventive and/or treatment algorithms of laryngospasm, although other authors have included it.3,8,66. From: Encyclopedia of . 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. If you have any of the conditions listed above, talk to your healthcare provider about ways to reduce your risk for laryngospasms. Accessed Nov. 5, 2021. Advertising revenue supports our not-for-profit mission. 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. font: 14px Helvetica, Arial, sans-serif; #mc_embed_signup { For laryngeal closure reflex, several types of receptors can be distinguished, according to their specific sensitivities to cold, pressure, laryngeal motion, and chemical agents.19,21The chemoreceptors are sensitive to fluids with low chloride or high potassium concentrations, as well as to strong acidic or alkaline solutions.19,21. To provide you with the most relevant and helpful information, and understand which PubMed PMID. The apneic reflex varies as a function of age. This function involves several upper airway reflexes: the laryngeal closure reflex, which consists of vocal fold adduction; apnea; swallowing; and coughing.19To efficiently protect the airway, laryngeal closure reflex must be coordinated with swallowing. This paper discusses a case study where the patient had laryngospasm, it also looks at the pathophysiology, risk factors and management of . The treatment includes opening and clearing the oropharynx, applying CPAP with 100% oxygen, followed by deepening of anaesthesia usually with an i.v . 2). Chris is an Intensivist and ECMO specialist at theAlfred ICU in Melbourne. Br J Anaesth 2009; 103:5669, Wong AK: Full scale computer simulators in anesthesia training and evaluation. 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. 1998 Nov;89(5):1293-4. However, if youve experienced laryngospasms in the past, your healthcare provider can determine whats causing them and find ways to reduce your risk. information highlighted below and resubmit the form. ANESTHESIOLOGY 2009; 110:28494, Baraka A: Intravenous lidocaine controls extubation laryngospasm in children. If youve experienced a laryngospasm, schedule an appointment with your healthcare provider. This situation creates a risk of bronchopulmonary infection, chronic cough, and bronchospasm. Fig. More children who developed laryngospasm were successfully treated with chest compression (73.9%) compared with those managed with the standard method (38.4%; P< 0.001). ANESTHESIOLOGY 2001; 95:299306, Lakshmipathy N, Bokesch PM, Cowen DE, Lisman SR, Schmid CH: Environmental tobacco smoke: A risk factor for pediatric laryngospasm. , the lateral cricoarytenoid, thyroarytenoid, and cricothyroid muscles. Keep the airway clear and monitor for negative pressure pulomnary oedema. 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. But it can be a symptom of other conditions, including: Left untreated, laryngospasm caused by anesthesia can be fatal. Sci Transl Med 2010; 2:19cm8. In the largest study published in the literature (n = 136,929 adults and children), the incidence of laryngospasm was 1.7% in 09 yr-old children and only 0.9% in older children and adults.7The highest incidence (more than 2%) was found in preschool age groups. border: none; It should be noted that hypoxia ultimately relaxes the vocal cords and permits positive pressure ventilation to proceed easily. scenario #2: the non-crashing epiglottitis patient. The breathing difficulty can be alarming, but it's not life-threatening. "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. In children, an artificial cough maneuver, including a single lung inflation maneuver with 100% O2immediately before removal of the ETT, is useful at the time of extubation because it delays or prevents desaturation in the first 5 min after extubation in comparison with a suctioning procedure.36Although not demonstrated in this study, this technique could reduce laryngospasm because when the endotracheal tube leaves the trachea, the air escapes in a forceful expiration that removes residual secretions from the larynx. Perianesthetic Management of Hypertrophic Cardiomyopathy, Copyright 2023 American Society of Anesthesiologists. Dry drowning has been explained by mechanisms such as protracted laryngospasm and vagally mediated cardiac arrest triggered by contact of liquid with the upper airways. Without quick recognition and proper treatment, the patient's airway may occlude, leading to respiratory arrest followed by cardiac arrest. Finally, third-level studies evaluate the effect of education on patient outcomes. anaesthesia: laryngospasm. Anaesthesia 1982; 37:11124, Postextubation laryngospasm. However, some authors have observed that emergence from anesthesia tends to become the most critical period, possibly in relation to changes in practice including the use of laryngeal mask airway (LMA) and/or of propofol and newer inhalational agents.8, Laryngospasm can result in life-threatening complications, including severe hypoxia, bradycardia, negative pressure pulmonary edema, and cardiac arrest. 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? However, a systematic approach based on the model of translational research has recently been proposed in medical education.79In this model, successive rigorous studies are conducted to evaluate the acquisition of skills and knowledge at different outcome levels. As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. Below a cardiac temperature of 28C, the heart may suddenly and spontaneously arrest. Their motoneurons are located in the brainstem nucleus ambiguous and the adjacent nucleus retroambigualis. , partial or complete) and of the bradycardia as well as the existence of contraindication to succinylcholine. Von Ungern-Sternberg et al. However, to our knowledge, no study has evaluated the effect of such a training approach on the management of laryngospasm. Table 1. #mc-embedded-subscribe-form .mc_fieldset { 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. Because laryngospasm is a potential life-threatening postoperative event, the PACU nurse 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. A single copy of these materials may be reprinted for noncommercial personal use only. . You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Paediatr Anaesth 2008; 18:3037. Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection? Paediatr Anaesth 2007; 17:15461, Guglielminotti J, Constant I, Murat I: Evaluation of routine tracheal extubation in children: Inflating or suctioning technique? Laryngospasm is a frightening condition that happens when your vocal cords suddenly seize up, making breathing more difficult. Stimulation of upper airway mucosa also produces cardiovascular (alterations of the arterial pressure, bradycardia, etc.) (#2) With steroid and antibiotic, most patients will gradually improve. Also find out about . Review. 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. 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. Laryngospasm may not be obvious it may present as increased work of breathing (e.g. The patient will then develop worsened hypotension, requiring the start of an epinephrine infusion. Other pharmacologic agents have been proposed for the prevention and/or treatment of laryngospasm, including magnesium,17doxapram,67diazepam,68and nitroglycerine.69However, because of the small number of patients included in these series no firm conclusions can be drawn. Target Audience: Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. This is because your vocal cords are contracted and closed tight during a laryngospasm. ,5emergent procedures had a moderately higher risk than elective procedures for perioperative respiratory adverse events, including laryngospasm (17%vs. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis. Both conditions result in sudden, frightening spasms and both conditions can temporarily affect your ability to breathe and speak. Journal of Voice. Management of refractory laryngospasm. By clicking Accept, you consent to the use of ALL the cookies. Eur Respir J 2001; 17:123943, Holm-Knudsen RJ, Rasmussen LS: Paediatric airway management: Basic aspects. Laryngospasm Administer 100% oxygen via nasal mask Suction the oropharynx, hypopharynx, and nasopharynx with a tonsil suction tip Suction/remove all blood, saliva, and foreign material from the oral cavity Pack the surgical site to prevent bleeding into the hypopharynx Draw the tongue and/or mandible forward In the case of laryngospasm, basic appropriate airway manipulations such as chin lift, jaw thrust, and oral airway insertion in combination with CPAP can be demonstrated and practiced with these models. Paediatr Anaesth 2002; 12:6258, Batra YK, Ivanova M, Ali SS, Shamsah M, Al Qattan AR, Belani KG: The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children. More needed than oxygen! } } OVERVIEW Laryngospasm is potentially life-threatening closure of the true vocal chords resulting in partial or complete airway obstruction unresponsive to airway positioning maneuvers. Recognizing laryngospasm - laryngospasm can occur spontaneously and be life-threatening, making it important that you be able to recognize it immediately. 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. Relaxation and breathing techniques may relieve symptoms and lessen the frequency or severity of laryngospasms in the future. 5 of 7 This document is not intended to provide a comprehensiv e discussion of each drug. #mc-embedded-subscribe-form input[type=checkbox] { GillesA. Orliaguet, Olivier Gall, GeorgesL. Savoldelli, Vincent Couloigner, Bruno Riou; Case Scenario: Perianesthetic Management of Laryngospasm in Children. Simulation-based Training Scenario Laryngospasm during Induction of General Anesthesia in a 10-month-old Boy. Refer to each drug's package Whereas epithelial damage heals in 12 weeks, virus-induced sensitization of bronchial autonomic efferent pathways can last for up to 68 weeks. 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. In contrast, results from studies in children with recent URIs have shown that LMA was associated with an increased occurrence of laryngospasm.28,32In a recent, large, prospective study, the incidence of laryngospasm was increased after direct stimulation of the upper airway by both LMA and ETT in comparison with a facemask.5Therefore, LMA may be considered more stimulating than the facemask but certainly less than the ETT. Usually, laryngospasm resolves and the patient recovers quickly without any sequelae. Laryngospasm. These interventions include removal of the irritant stimulus,8,38chin lift, jaw thrust,39continuous positive airway pressure (CPAP), and positive pressure ventilation with a facemask and 100% O2.3,40,,43These maneuvers are popular because they have been shown to improve the patency of the upper airway in case of airway obstruction.42,4445Less commonly used airway maneuvers, such as pressure in the laryngospasm notch4,44and digital elevation of the tongue46also have been proposed as rapid and effective methods.8Overall conflicting results have been obtained regarding the best maneuver to relieve airway obstruction in children with laryngospasm.