Seizure-induced laryngospasm during a paediatric sevoflurane induction

Seizures during anaesthesia are rare, but potentially serious, especially in paediatric patients. This case report describes a 6-year-old child who developed seizure-induced laryngospasm during inhalational induction of anaesthesia with sevoflurane for adenotonsillectomy. The child exhibited rhythmic upper limbs, jaw and facial twitching accompanied by complete laryngospasm, requiring urgent intervention. A bolus of propofol 50 mg (1.9 mg.kg^-1) terminated the seizure, while suxamethonium 40 mg (1.5 mg.kg^-1) was required to relieve the laryngospasm and secure the airway. There was no evidence of secretions, regurgitation or inadequate depth of anaesthesia which could have precipitated the laryngospasm. This is the first reported human case of suspected seizure-induced laryngospasm potentially mediated via recurrent laryngeal nerve activation under anaesthesia, a mechanism previously demonstrated only in animals. This observation provides rare clinical support for a neurogenic cause of laryngospasm. Additional cases supporting the proposed mechanism and the pro-epileptogenic potential of sevoflurane are discussed.