Standardized Crisis Format
Laryngospasm
Closed glottis with difficult ventilation, stridor, or silent obstruction.
Last reviewed
2026-05-28
Call for help. Declare emergency. Assign a reader and team roles.
1
Recognition
- Silent airway obstruction
- Inspiratory effort without airflow
- Stridor (partial closure)
- Absent or markedly reduced ETCO2
- Paradoxical chest movement
- Rapid desaturation
- Increasing respiratory effort
2
Management Algorithm
Primary pathway. Work step-by-step and escalate early if oxygenation is not rapidly restored.
1
Step 1
Call for Help
- Call for assistance
- Stop surgical stimulation if possible
- Administer 100% oxygen
- Optimise airway positioning
- Perform firm jaw thrust
- Avoid aggressive, repeated, or unnecessary suctioning, as additional airway stimulation may worsen laryngospasm
2
Step 2
Apply CPAP
- Apply CPAP 10-20 cmH2O
- Maintain a tight mask seal
- Avoid repeated aggressive ventilation attempts
- Consider Larson's manoeuvre if part of local practice
3
Step 3
Deepen Anaesthesia
Propofol IV
- Adult: 0.5-1 mg/kg IV
- Child: 0.5-1 mg/kg IV
4
Step 4
If Not Resolving Immediately
Suxamethonium
- IV: 0.1-0.5 mg/kg
- Full paralysis: 1-2 mg/kg IV
- If no IV access: IM 4 mg/kg
5
Step 5
Manage Bradycardia
Atropine
- Child: 0.02 mg/kg IV
- Minimum dose: 0.1 mg
- Maximum single dose: 0.5 mg
6
Step 6
Ventilate and Secure Airway
- Assist ventilation
- Insert airway adjuncts as required
- Intubate if clinically indicated
- Continue monitoring
3
Drug Reference
Propofol
- Dose: 0.5-1 mg/kg IV
- Onset: 30-60 sec
- Duration: 5-10 min
- Useful for breaking laryngospasm without paralysis
Suxamethonium
- Dose: 0.1-0.5 mg/kg IV
- Full paralysis: 1-2 mg/kg IV
- IM: 4 mg/kg
- Onset IV: 30-60 sec
- Duration: 5-10 min
Atropine
- Dose: 0.02 mg/kg IV
- Onset: 1-2 min
- Duration: 30-60 min
- Particularly useful in children with significant bradycardia
4
Additional Information
Risk Factors
- Recent URTI
- Airway surgery
- Secretions
- Light anaesthesia
- Paediatric patients
- Airway manipulation
Complications
- Severe hypoxaemia
- Bradycardia
- Cardiac arrest
- Negative-pressure pulmonary oedema
- Aspiration
5
Clinical Pearls
- Early CPAP and jaw thrust are often sufficient.
- Propofol frequently breaks laryngospasm before muscle relaxants are required.
- Small doses of suxamethonium may be effective before full paralysis is necessary.
- Persistent desaturation should prompt rapid progression to paralysis and airway control.
- After severe laryngospasm, assess for negative-pressure pulmonary oedema.
Source label
Association of Anaesthetists QRH-inspired
Concise demo/reference summary written for Anaes App. It is not a copied guideline and must be checked against local protocols.