Laryngospasm Treated With Intramuscular Rocuronium in a Pediatric Patient Without Intravenous Access: A Case Report

Area of Science:

• Pediatric Anesthesiology
• Emergency Medicine
• Pharmacology

Background:

• Laryngospasm is a critical airway emergency in pediatric anesthesia.
• Rapid intervention is crucial to prevent hypoxia and adverse outcomes.
• Intravenous access may be challenging in emergent pediatric situations.

Observation:

• Mask ventilation became impossible in an 11-month-old infant during induction of anesthesia.
• Intravenous access was unsuccessful, and succinylcholine was unavailable.
• Intramuscular rocuronium (1.0 mg/kg) was administered into the vastus lateralis muscle.

Findings:

• Successful mask ventilation was achieved within one minute after intramuscular rocuronium administration.
• Endotracheal intubation was subsequently performed using a video laryngoscope.
• The duration of hypoxia (SpO2 < 90%) was approximately two minutes, with a lowest saturation of 76%.

Implications:

• Intramuscular rocuronium represents a viable alternative for treating pediatric laryngospasm when IV access is unavailable.
• This route of administration may be a critical option in resource-limited settings or emergencies.
• Further studies are warranted to establish the safety and efficacy of intramuscular rocuronium in pediatric airway emergencies.