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). Laryngospasm LITFL Medical Blog CCC Ventilation Copyright 2012, the American Society of Anesthesiologists, Inc. Perianesthetic Management of Laryngospasm in Children, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0b013e318242aae9, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Perianesthetic Dental Injuries : Frequency, Outcomes, and Risk Factors, Understanding the Mechanics of Laryngospasm Is Crucial for Proper Treatment, Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane. 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. This scenario illustrates the potential risks of not managing your resources properly. The apneic reflex varies as a function of age. In the recent analysis of 189 reports of laryngospasm to the Australian Incident Monitoring Study, one in three patients suffered significant physiological disturbance. Prospective studies supported the use of LMA over ETT in children with URI.3031However, these studies were underpowered to detect differences in laryngospasm. Mayo Clinic does not endorse any of the third party products and services advertised. Perianesthetic Management of Hypertrophic Cardiomyopathy, Copyright 2023 American Society of Anesthesiologists. The team must initiate usual anaphylaxis treatment including salbutamol for bronchospasm. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis. The onset of a vocal cord spasm is sudden, and just as suddenly, it goes away, usually after . A 0.2-mg IV bolus dose of atropine was injected and IV succinylcholine was given at a dose of 16 mg, followed by tracheal intubation. Laryngospasm (luh-RING-o-spaz-um) is a condition in which your vocal cords suddenly spasm (involuntarily contract or seize). The patient is unconscious and initially breathing easily with an oral airway in place. As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. , the overall incidence of respiratory adverse events seems to be higher in children who were awake when their LMA was removed and lower in those who were awake when their endotracheal tube was removed.5In summary, evidence seems to favor deep LMA and awake ETT removal. 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. J Appl Physiol 1998; 84:202035, Menon AP, Schefft GL, Thach BT: Apnea associated with regurgitation in infants. Epiglottitis - EMCrit Project Singapore Med J 1998; 39:32830, Warner DO: Intramuscular succinylcholine and laryngospasm. 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. 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. In the study by von Ungern-Sternberg et al. 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? Pulm Pharmacol 1996; 9:3437, Shannon R, Baekey DM, Morris KF, Lindsey BG: Ventrolateral medullary respiratory network and a model of cough motor pattern generation. He has a known allergy to peanuts. #mergeRow-gdpr fieldset label { Laryngospasm: What causes it? - Mayo Clinic Upper airway disorders. Many methods and techniques of airway manipulation have been proposed. Propofol depresses laryngeal reflexes33,48and is therefore widely used to treat laryngospasm in children.3,49A study has assessed the effectiveness of a small bolus dose of propofol (0.8 mg/kg) for treatment of laryngospasm when 100% O2with gentle positive pressure had failed.49In this study, propofol was administered if laryngospasm occurred after LMA removal and if it persisted with a decrease in SpO2to 85% despite 100% O2with gentle positive pressure ventilation.49The injection of propofol was able to relieve spasm in 76.9% of patients, whereas the remaining patients required administration of succinylcholine and tracheal intubation.49The success rate of propofol observed in this study is superior to the chest compression technique mentioned previously. Learning breathing techniques can help you remain calm during an episode. 21,22. . A single copy of these materials may be reprinted for noncommercial personal use only. 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. According to Phil Larson: This notch is behind the lobule of the pinna of each ear. 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. Fig. If youve had recurring laryngospasms, you should see your healthcare provider to find out whats causing them. Review/update the TeamSTEPPS 2.0 Specialty Scenarios - 85 Specialty Scenarios OR Scenario 68 Appropriate for: All Specialties . Laryngospasm can sometimes occur after an endotracheal tube is removed from the throat. Paediatr Anaesth 2008; 18:3037. The goal is to slow your breathing and allow your vocal cords to relax. Anesthesia was induced by a resident under the direct supervision of a senior anesthesiologist with inhaled sevoflurane in a 50/50% (5 l/min) mixture of oxygen and nitrous oxide. Such a conservative attitude has already been proposed for otolaryngology patients, whose surgery is expected to have an effect on the recurrence of URI episodes.11Premedication with anticholinergic agents may decrease secretions but has no demonstrated influence on the incidence of laryngospasm.7,29. other information we have about you. URI = upper respiratory tract infection. Click here for an email preview. SimBaby - Laerdal Medical Based on a work athttps://litfl.com. Laryngospasm in anaesthesia | BJA Education | Oxford Academic This means that if nothing has occurred 46 h after the occurrence of a laryngospasm it is likely that the course will be uneventful. He created the Critically Ill Airway course and teaches on numerous courses around the world. Only sevoflurane or halothane should be used for inhalational induction. Identifying the risk factors and planning appropriate anesthetic management is a rational approach to reduce laryngospasm incidence and severity. The cause of vocal cord spasms is often unknown, and it is usually in response to a trigger such as anxiety or acid reflux. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). For example, if laryngospasms are linked to GERD, then treating chronic acid reflux can also reduce your risk for laryngospasm. Muscle relaxants are usually administered when initial steps of laryngospasm treatment have failed to relax the vocal cords. However, waiting until hypoxia opens the airway is not recommended, because a postobstruction pulmonary edema or even cardiac arrest may occur.43. Khanna S (expert opinion). It should be suspected whenever airway obstruction occurs, particularly in the absence of an obvious supraglottic cause. include protected health information. Paediatr Anaesth 2004; 14:15866, Olsson GL, Hallen B: Laryngospasm during anaesthesia. Postoperative management of the difficult airway | BJA Education But it can be a symptom of other conditions, including: Left untreated, laryngospasm caused by anesthesia can be fatal. None of the children in the chest compression group developed gastric distension (86.5% in the standard group). (Staff Anesthesiologist, Department of Anaesthesia, Children's University Hospital, Dublin, Ireland), for kindly reviewing the manuscript; Hlne Mathey-Doret, M.D. Anaesthesia 2002; 57:1036, Chung DC, Rowbottom SJ: A very small dose of suxamethonium relieves laryngospasm. . Paediatr Anaesth 2008; 18:3037, von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W: Risk assessment for respiratory complications in paediatric anaesthesia: A prospective cohort study. 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. 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. Laryngospasm remains the leading cause of perioperative cardiac arrest from respiratory origin in children.1, The upper airway has several functions (swallowing, breathing, and phonation) but protection of the airway from any foreign material is the most essential. Am J Respir Crit Care Med 1998; 157:81521, von Ungern-Sternberg BS, Boda K, Schwab C, Sims C, Johnson C, Habre W: Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. } Laryngospasm, particularly during inhalational induction and after extubation, is an important cause of apnea that all anesthesiologists who care for pediatric patients should understand and anticipate. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Anesthesiology. It may be difficult for a nonspecialist pediatric anesthesiologist to adequately manage an inhalational induction, because of the possibility to fail to manage the airway properly or the inability to recognize and treat early a stridor/laryngospasm. No chest wall movement with no breath sounds on auscultation, Inability to manually ventilate with bag-mask ventilation, ischemic end organ injury (e.g. It is still debated whether tracheal extubation should be performed in awake or deeply anesthetized children to decrease laryngospasm. Chris is an Intensivist and ECMO specialist at theAlfred ICU in Melbourne. Laryngospasm: Stimulation of vagus nerve during light anesthesia (Superior Laryngeal n, pharyngeal br of vagus, recurrent laryngeal below cords). c. Treatment of laryngospasm is aimed at supporting ventilation. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Difficulty breathing ( dyspnea) Fatigue and exhaustion are other less-common and more subtle symptoms that may be associated with bronchospasm. Laryngospasm is an emergency situation and must be promptly recognized. ,5emergent procedures had a moderately higher risk than elective procedures for perioperative respiratory adverse events, including laryngospasm (17%vs. Case Scenario: Acute Postoperative Negative Pressure Pulmonary Edema Paediatr Anaesth 2002; 12:7629, Tait AR, Pandit UA, Voepel-Lewis T, Munro HM, Malviya S: Use of the laryngeal mask airway in children with upper respiratory tract infections: A comparison with endotracheal intubation. Journal of Voice. OVERVIEW Laryngospasm is potentially life-threatening closure of the true vocal chords resulting in partial or complete airway obstruction unresponsive to airway positioning maneuvers. The SimBaby simulator represents a 9-month-old pediatric patient and provides a highly realistic manikin that meets specific learning objectives focusing on initial assessment and treatment. If you are a Mayo Clinic patient, this could Most of the time, your healthcare provider can diagnose laryngospasm by reviewing your symptoms and medical history. Afferent nerves converge in the brainstem nucleus tractus solitarius. Table 1. In: Murray and Nadel's Textbook of Respiratory Medicine. It is a primitive protective airway reflex that exists to . Laryngoscope 2006; 116:1397403, Nishino T, Hasegawa R, Ide T, Isono S: Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. Anaesthesia 1998; 53:91720, Ko C, Kocaman F, Aygen E, Ozdem C, Ceki A: The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. Rarely, negative pressure pulmonary edema may occur and requires specific treatment.37The high chest wall to lung compliance ratio observed during infancy, which disappears by the second year of life because of increased chest wall stiffness, may explain why negative pressure pulmonary edema is less frequent in infants than in older children or adults. All rights reserved. Br J Anaesth 2001; 86:21722, Mark LC: Treatment of laryngospasm by digital elevation of tongue (letter). Case Scenario Perianesthetic Management of Laryngospasm In; Hazard Identification and Risk Assessment; Permit to Work Ensuring a Safe Work Environment Introduction Industrial Workers Face Many Hazards in Their Daily Routines; Health Surveillance Employer's Pack; Incidence and Associated Factors of Laryngospasm Among Pediatric 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. 2021; doi: 10.1016/j.jvoice.2020.01.004. A new episode of laryngospasm was immediately suspected. PDF Airway Management: Use of Succinylcholine or Rocuronium 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. The question of whether using propofol or muscle relaxant first is a matter of timing. laryngospasm - EM Sim Cases 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. Keep the airway clear and monitor for negative pressure pulomnary oedema. His one great achievement is being the father of three amazing children. Laryngospasm is a frightening condition that happens when your vocal cords suddenly seize up, making breathing more difficult. We decided to omit it in the preventive and/or treatment algorithms of laryngospasm, although other authors have included it.3,8,66. Common triggers of reflex laryngeal response during anesthesia are secretions, blood, insertion of an oropharyngeal airway suction catheter, and laryngoscopy. Among all upper airway reflexes, it is the most resistant to deepening anesthesia, whereas the coughing reflex is the most sensitive. They can determine the cause of your laryngospasms and recommend an appropriate treatment plan. Accessed Nov. 5, 2021. Ann Otol Rhinol Laryngol 2005; 114:25863, Thach BT: Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life. We also use third-party cookies that help us analyze and understand how you use this website. 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. Management of refractory laryngospasm. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. font: 14px Helvetica, Arial, sans-serif; The procedure was expected to be very short, and general anesthesia with inhalational induction and maintenance, but without tracheal intubation, was planned. 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. suggests that maintenance with sevoflurane was associated with a higher incidence of laryngospasm compared with propofol (relative risk 2.37, 95% CI 1.493.76; P< 0.0001).5In our case, the second episode of laryngospasm occurred while the patient was under light anesthesia. Breathe in slowly through your nose. 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. GillesA. Orliaguet, Olivier Gall, GeorgesL. Savoldelli, Vincent Couloigner, Bruno Riou; Case Scenario: Perianesthetic Management of Laryngospasm in Children. Shortness of breath. APPENDIX. Laryngospasm: Causes, Symptoms, and Treatments - WebMD Learning objectives should be based on recommended management algorithms and used as inputs and events embedded into one (or several) case scenario that form the basis for the simulated exercise. PDF Case Scenario: Perianesthetic Management of Laryngospasm in Children 2. 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. For the management of laryngospasm in children, this task is complicated by two facts. Review. Risk Factors Associated with Perioperative Laryngospasm, Young age is one of the most important risk factors. Identifying patients at increased risk for laryngospasm and taking recommended precautions are the most important measures to prevent laryngospasm (fig. These risk factors can be Last reviewed by a Cleveland Clinic medical professional on 02/11/2022. and bronchomotor reflexes, indicating that not only skeletal but also smooth muscles are involved in upper airway reflexes.19. Anaesthesia 2007; 62:7579, Tobias JD, Nichols DG: Intraosseous succinylcholine for orotracheal intubation. However, to our knowledge, no study has evaluated the effect of such a training approach on the management of laryngospasm. Laryngospasm (Pediatric) | SpringerLink The first step of laryngospasm management is prevention. A characteristic crowing noise may be heard in partial laryngospasm but will be absent in complete laryn-gospasm. #mc-embedded-subscribe-form .mc_fieldset { 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. PubMed PMID: Orliaguet GA, Gall O, Savoldelli GL, Couloigner V. Case scenario: perianesthetic management of laryngospasm in children. American Academy of Allergy, Asthma and Immunology. In addition, a video of a simulated layngospasm scenario is available (See video, Supplemental Digital Content 1, http://links.lww.com/ALN/A807, which demonstrates the management of a simulated laryngospasm in a 10-month-old boy). 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. | INTENSIVE | RAGE | Resuscitology | SMACC. information and will only use or disclose that information as set forth in our notice of Learn how your comment data is processed. But opting out of some of these cookies may have an effect on your browsing experience. GERD: Can certain medications make it worse? Minimally invasive anti-reflux procedures, Advertising and sponsorship opportunities. We do not endorse non-Cleveland Clinic products or services. display: inline; These preliminary results are interesting and need to be confirmed by further studies. The child was placed over a forced air warmer (Bear Hugger, Augustine Medical, Inc., Eden Prairie, MN). 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. can occur spontaneously, most commonly associated with extubation or ENT procedures CAUSES Local extubation especially children with URTI symptoms It is mandatory to procure user consent prior to running these cookies on your website. Used with permission of John Wiley and Sons. Cleveland Clinic is a non-profit academic medical center. 14%, relative risk 1.2, 95% CI 1.11.3; P= 0.001). ANESTHESIOLOGY 1963; 24:585, Al-Metwalli RR, Mowafi HA, Ismail SA: Gentle chest compression relieves extubation laryngospasm in children. ANESTHESIOLOGY 2010; 113:2007, Roy WL, Lerman J: Laryngospasm in paediatric anaesthesia. 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). clear: left; First, the introduction of working hour limitations in virtually all Western countries has decreased the number of pediatric cases performed by trainees.71Second, most anesthetics given to children are administered by nonspecialists whose lack of experience and inability to maintain their skill set for children is a problem. 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). Laryngospasm usually isnt life-threatening, but it can be a terrifying experience. 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. Laryngospasm was treated by 50 mg propofol and manual positive pressure mask ventilation with 100% inspired oxygen. . These cookies will be stored in your browser only with your consent. Any stimulation in the area supplied by the superior laryngeal nerve, during a light plane of anesthesia, may produce laryngospasm. width: auto; 1998 Nov;89(5):1293-4. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australias Northern Territory, Perth and Melbourne. , the lateral cricoarytenoid, thyroarytenoid, and cricothyroid muscles. The purpose of this case scenario is to highlight key points essential for the prevention, diagnosis, and treatment of laryngospasm occurring during anesthesia. Case Scenario: Perianesthetic Management of Laryngospasm in Children Case Scenario: Perianesthetic Management of Laryngospasm in Children Case Scenario: Perianesthetic Management of Laryngospasm in Children Case Scenario: Perianesthetic Management of Laryngospasm in Children Anesthesiology. Laryngospasm is the sustained closure of the vocal cords resulting in the partial or complete loss of the patient's airway. #Management #EM #Anesth #PCC #Laryngospasm #Algorithm #Complete #Partial. It is most commonly occurring on induction or emergence phases and can have serious life threatening consequences. font-weight: normal; However, onset time to effective relief of laryngospasm is shorter than onset time to maximal twitch depression, enabling laryngospasm relief and oxygenation (within 60 s) in less time than time to maximum twitch depression.55Therefore, intramuscular succinylcholine is the best alternative approach if IV access is not readily available.56Another alternative for succinylcholine administration is the intraosseous route. Policy. [PDF] Case scenario: perianesthetic management of laryngospasm in Symptoms can be mild or severe. As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. 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. 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. Recognizing laryngospasm - laryngospasm can occur spontaneously and be life-threatening, making it important that you be able to recognize it immediately. The treatment includes opening and clearing the oropharynx, applying CPAP with 100% oxygen, followed by deepening of anaesthesia usually with an i.v . Inexperience of the anesthetist is also associated with an increased incidence of laryngospasm and perioperative respiratory adverse events.2,5,18Some factors are associated with a lower risk of laryngospasm: IV induction, airway management with facemask, and inhalational maintenance of anesthesia.5Induction and emergence from anesthesia are the most critical periods.

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