Risk factors for laryngospasm in children during general anesthesia.
BACKGROUND
Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children.


METHODS
The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case-control study.


RESULTS
No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P = 0.022) and the presence of an airway anomaly (OR = 3.35, P = 0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly (P = 0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls (P = 0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort.


CONCLUSIONS
In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.
Flick
Randall P
RP
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Wilder
Robert T
RT
Pieper
Stephen F
SF
van Koeverden
Kevin
K
Ellison
Kyle M
KM
Marienau
Mary E S
ME
Hanson
Andrew C
AC
Schroeder
Darrell R
DR
Sprung
Juraj
J
D000402:Airway Obstruction / Q000150:complications; D000768:Anesthesia, General / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017214:Laryngeal Masks / Q000009:adverse effects; D007826:Laryngismus / Q000209:etiology*; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012141:Respiratory Tract Infections / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution