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Risk factors for laryngospasm in children during general anesthesia
Randall P Flick1, Robert T Wilder, Stephen F Pieper
1Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Children with upper respiratory infections or airway anomalies face increased laryngospasm risk during anesthesia. Laryngeal mask airway use also elevates this risk, even with pre-existing conditions.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Respiratory Medicine
Background:
- Laryngospasm is a frequent and serious respiratory complication during pediatric anesthesia.
- Identifying risk factors is crucial for preventing adverse events in children.
Purpose of the Study:
- To investigate demographic, patient, surgical, and anesthetic risk factors for laryngospasm in children.
- To determine associations between specific conditions and airway devices with laryngospasm incidence.
Main Methods:
- A case-control study involving 130 pediatric patients who experienced laryngospasm under general anesthesia.
- Analysis of prospectively collected data from the Mayo Clinic performance improvement database (1996-2005).
Main Results:
- Upper respiratory infection (URI) and airway anomalies were significantly associated with increased laryngospasm risk.
- Laryngeal mask airway (LMA) use showed a strong association with laryngospasm, independent of URI or airway anomalies.
- Patients experiencing laryngospasm had a higher incidence of postoperative complications.
Conclusions:
- Pediatric patients with URI or airway anomalies are at higher risk for laryngospasm.
- LMA use is a significant risk factor for pediatric laryngospasm, even after accounting for other risk factors.
Background:
Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children.
Material And Methods:
The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case-control study.
Results:
No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P = 0.022) and the presence of an airway anomaly (OR = 3.35, P = 0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly (P = 0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls (P = 0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort.
Conclusions:
In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.
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