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  • Involuntary closure of the vocal cords leading to airway obstruction with folding over of epiglottis

  • Delayed treatment can lead to:

    • ↓O2, ↓HR, negative pressure pulmonary edema, aspiration & cardiac arrest


  • Can occur anytime (induction, emergence, maintenance) while in a light plane of anesthesia

  • Needs to be recognized and treated rapidly

  • Risk factors:

    • Airway manipulation

    • Vocal cord irritation (blood or mucus etc.)

    • Young age (i.e. infants)

    • URTI

    • OSA

    • Altered airway anatomy

    • Procedures on the airway (e.g. tonsillectomy)

  • Signs & symptoms:

    • inspiratory stridor

    • Retrosternal/substernal retractions

    • Rocking movement with inspiration



  • 100% O2 with facemask + CPAP + optimize airway position +/- OPA

  • Consider Larson's maneuver (bilateral firm digital pressure on the styloid process behind the posterior ramus of the mandible)

  • Deepen anesthesia (i.e. propofol or volatile agent)

  • Definitive treatment:

    • Succinycholine 0.25-0.5 mg/kg IV

    • Atropine 0.02mg/kg IV ready for bradycardia

    • BMV until muscle relaxant wears off


  • Delay surgery if recent URTI

  • Suction!

  • Manipulate airway only during deep plane of anesthesia

  • Avoid ETT (use LMA instead) for > 1 y/o's

    • If intubating using NDMR

  • Lidocaine IV prior to extubation 


Jagannathan, N. (2021, October). Complications of pediatric airway management for anesthesia. UpToDate. Retrieved November 5, 2021.


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