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Laryngospasm in Infants — FRCA Final MCQ

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HardPaediatric AnaesthesiaLaryngospasm in InfantsFRCA Final

A 9-month-old infant weighing 8 kg undergoes inhalational induction with sevoflurane for inguinal hernia repair. Before intravenous access is established, complete laryngospasm develops. SpO2 has fallen to 78% and the heart rate is decreasing despite removal of airway stimuli, jaw thrust and continuous positive airway pressure with 100% oxygen. What is the next most appropriate step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Administer suxamethonium 4 mg/kg intramuscularly

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

C is correct. This is complete laryngospasm with rapidly worsening hypoxaemia and bradycardia after appropriate basic manoeuvres, but without intravenous access. The Association of Anaesthetists QRH specifies intramuscular suxamethonium 4 mg/kg: this infant requires 32 mg. Continue 100% oxygen and CPAP, and prepare to ventilate and intubate when relaxation occurs. Establishing intraosseous access may be useful but should not delay immediately available intramuscular suxamethonium. Further sevoflurane cannot reliably deepen anaesthesia during complete obstruction because no volatile agent reaches the lungs. Intramuscular rocuronium has a less established and less predictable role and causes prolonged blockade. Emergency front-of-neck access is reserved for persisting cannot-intubate–cannot-oxygenate failure after appropriate pharmacological airway rescue.

Reference: Association of Anaesthetists, Quick Reference Handbook, section 3-6: Laryngospasm and stridor, 2018. https://www.rcoa.ac.uk/media/9386