Gentle chest compression relieves extubation laryngospasm in children

Abstract

Extubation laryngospasm is frequently encountered in children undergoing upper airway surgery. Different drugs and techniques have been used for its treatment. The objective of this study was to examine gentle chest compression as an alternative to standard practice for relief of laryngospasm. This study was conducted over 4 years on all children scheduled for elective tonsillectomy. During the first 2 years, extubation laryngospasm was managed with 100% O₂ with gentle positive pressure ventilation via a tight-fitting face mask (Standard-Practice Group), whereas in the following 2 years; laryngospasm was managed with 100% O₂ and concurrent gentle chest compression (Chest-Compression Group). In both groups, if the spasm was not relieved and oxygen saturation decreased to 85%, IV succinylcholine was administered with subsequent manual ventilation. During the 4-year study period, 1226 children aged 3-12 years were studied. In the chest-compression group, 46/594 children (7.8%) developed laryngospasm compared with 52/632 children (8.2%) in the standard group (P = 0.84). Significantly more children who developed laryngospasm were successfully treated by chest compression 34/46 (73.9%) compared with those managed by the standard method 20/52 (38.4%); (P < 0.001). None of the children in the chest-compression group developed gastric distension compared with 45/52 (86.5%) in the standard group. Gentle chest compression with 100% oxygen is a simple and effective technique for immediate management of post extubation laryngeal spasm in children.