mandible, pull the chin up, jutting the jaw out), can alleviate
obstruction caused by the epiglottis protruding into the airway. A
third maneuver, usually done along with the first two, is to use con-
tinuous positive airway pressure (CPAP), which distends all the soft
tissues of the pharynx and larynx. If these maneuvers are ineffec-
tive, oral airway insertion will likely relieve the obstruction, espe-
cially in children with large tonsil or adenoid tissue. Deliver rapid
ventilations at a high inspiratory pressure until the child's chest rises
and adequate ventilation is confirmed.
5 3
J U N E 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
Unanticipated airway obstruction is alarming, especially in small infants, because
they desaturate so quickly. The most serious complication you'll likely see in outpa-
tient centers is laryngospasm. Untreated, it usually resolves by itself, but it can be
catastrophic if it doesn't resolve right away. Certain risk factors are associated with
increased likelihood of laryngospasm, including active or recent upper respiratory
infection and chronic exposure to second-hand smoke. The distinction between par-
tial and complete upper airway obstruction is important, because the best way to
treat laryngospasm differs between the two.
• Partial upper airway obstruction. In a partial obstruction, recognizable by the
presence of high-pitched inspiratory stridor, a small amount of air can enter with the
administration of positive-pressure ventilation. Often, this prevents hypoxemia and lets
anesthetic gases pass, deepening the level of unconsciousness and alleviating the
laryngospasm.
• Complete upper airway obstruction. This usually rapidly results in hypox-
emia. Avoid positive airway pressure, which may exacerbate the problem. Instead,
administer succinylcholine, intravenously if you can, but intramuscularly, if neces-
sary. — Ronald S. Litman, DO
RAPID DESATURATION
Recognizing Laryngospasm in Infants
