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• W2755182794 abstract "Editor—Perioperative laryngospasm is a life-threating emergency in paediatric patients. A recent multicentre study of children undergoing surgery1Habre W Disma N Virag K et al.Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe.Lancet Respir Med. 2017; 5: 412-425Abstract Full Text Full Text PDF PubMed Scopus (359) Google Scholar found a high rate of severe critical events during the perioperative period (5.2%), with an incidence of respiratory critical events of 3.1%. Laryngospasm was one of most frequent respiratory complications (0.2–6.7%). Its effective management requires appropriate diagnosis, followed by prompt and aggressive management. The use of a structured algorithm would lead to earlier recognition and better management.2Visvanathan T Kluger MT Webb RK Westhorpe RN Crisis management during anaesthesia: laryngospasm.Qual Saf Health Care. 2005; 14: e3Crossref PubMed Scopus (81) Google Scholar We undertook a survey in order to explore the practical management of laryngospasm by French paediatric anaesthetists. Members of the French-speaking Paediatric Anaesthetists and Intensivists Association (ADARPEF) were invited to answer an online survey (from June to November 2016). The survey consisted of different sections: basic professional characteristics, estimated incidence of laryngospasm, existence of a local algorithm and questions about the management of laryngospasm. Statistical analyses consisted of descriptive statistics displayed as mean (SD) for continuous variables and N (%) for discrete ones. Overall, 107 physicians completed the survey (21% of association members). A majority (77%) of respondents worked in public hospitals (56% in a university hospital). About 73% of respondents indicated that they had been practicing paediatric anaesthesia for at least 5 yr, and 39% indicated they were exclusively engaged in paediatric anaesthesia practice. 57% practiced anaesthesia for both adults and children, and 80% indicated they anaesthetized neonates in their practice. Surgeries covered by respondents included otolaryngology (92%), abdominal and urologic surgery (89%), orthopaedic surgery (85%), endoscopy (81%), ophthalmology (78%) and anaesthesia for imaging (69%). Less frequent procedures included neurosurgery (45%) and cardiac surgery (15%). Most respondents (63%) considered laryngospasm to be a frequent (1/100-500 paediatric anaesthetics) or a very frequent event (1/10-100 paediatric anaesthetics). A majority (67%) do not have an algorithm for management of laryngospasm. Data concerning the management of laryngospasm are summarized in Table 1.Table 1Management of laryngospasm by respondentsManagement of laryngospasmPaediatric Anaesthetists n=107Diagnosis Tracheal tug, suprasternal and supraclavicular retractions79% Desaturation78% Stridor72%Airway manipulation Removal of the irritant stimulus84% 100% oxygen84% Jaw thrust82% Chin lift65% Positive pressure ventilation with a facemask76% Continuous positive airway pressure (CPAP)17%1st Pharmacological agent if the spasm persists Propofol99% Suxamethonium (+ atropine)1%2nd pharmacological agent if the spasm persists Propofol15% Suxamethonium (+ atropine)85%Doses of propofol 1 mg kg−131% 2 mg kg−143% 3–5 mg kg−126%Doses of Suxamethonium 0.2–0.5 mg kg−117% 1–2 mg kg−1 according to age76% Never use Suxamethonium7% Open table in a new tab Many authors recommend methods of airway manipulation in laryngospasm including removal of the irritant stimulus,3Roy WL Lerman J Laryngospasm in paediatric anaesthesia.Can J Anaesth J Can Anesth. 1988; 35: 93-98Crossref PubMed Scopus (62) Google Scholar chin lift, jaw thrust,4Fink BR The etiology and treatment of laryngeal spasm.Anesthesiology. 1956; 17: 569-577Crossref PubMed Scopus (55) Google Scholar continuous positive airway pressure (CPAP), and positive pressure ventilation using a face mask and 100% oxygen.5Holm-Knudsen RJ Rasmussen LS Paediatric airway management: basic aspects.Acta Anaesthesiol Scand. 2009; 53: 1-9Crossref PubMed Scopus (56) Google Scholar According to our results, few anaesthetists used CPAP despite the previously known risk of stomach distension and the increasing risk of gastric regurgitation associated with positive pressure ventilation.6Orliaguet GA Gall O Savoldelli GL Couloigner V Case scenario: perianesthetic management of laryngospasm in children.Anesthesiology. 2012; 116: 458-471Crossref PubMed Scopus (39) Google Scholar In case of persistent laryngospasm, almost all the respondents agreed on the choice of propofol as the first pharmacological agent. Propofol depresses laryngeal reflexes and is therefore widely used to treat laryngospasm in children.7Oberer C von Ungern-Sternberg BS Frei FJ Erb TO Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients.Anesthesiology. 2005; 103: 1142-1148Crossref PubMed Scopus (97) Google Scholar8Afshan G Chohan U Qamar-Ul-Hoda M Kamal RS Is there a role of a small dose of propofol in the treatment of laryngeal spasm?.Paediatr Anaesth. 2002; 12: 625-628Crossref PubMed Scopus (54) Google Scholar However, the optimal dose of propofol is not clearly defined. In our study, the most common dose of propofol was 2 mg kg−1 (43%). Neuromuscular blocking agents are usually administered when propofol fails to alleviate laryngospasm. Interestingly, this situation occurred in only 14% of cases in the Apricot Trial.1Habre W Disma N Virag K et al.Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe.Lancet Respir Med. 2017; 5: 412-425Abstract Full Text Full Text PDF PubMed Scopus (359) Google Scholar The main findings of this survey include 1) lack of a structured algorithm for management of laryngospasm in most institutions, 2) differences in mode of ventilation during laryngospasm, and 3) variability in doses of drugs used to alleviate laryngospasm. Otherwise clinical signs that trigger treatment were consistent and in accordance with the literature. Further studies are needed to clarify the optimal ventilation during laryngospasm and the optimal i.v. doses of the pharmacological agents. Study design/planning: D.M., A.S., S.D. Study conduct: V.L., S.D. Data analysis: D.M., B.G., V.L., S.D. Writing paper: D.M., V.L., S.D. Revising paper: all authors Authors thank Dr. A Laffargue (president of the ADARPEF) for her help in the survey. Also, many thanks to all respondents who made possible the current study. None declared." @default.
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• W2755182794 title "Management of perioperative laryngospasm by French paediatric anaesthetists" @default.
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