Elsevier; 2022. https://www.clinicalkey.com. Table 1. 2). Description The patient requires intubation, but isn't actively crashing. Immediately after extubation, the patient developed inspiratory stridor consistent with laryngospasm; the anesthesiologist had difficulty in mask ventilating the patient, and peripheral oxygen saturation decreased to less than 80%. It is still debated whether tracheal extubation should be performed in awake or deeply anesthetized children to decrease laryngospasm. Anesthesia was induced by a resident under the direct supervision of a senior anesthesiologist with inhaled sevoflurane in a 50/50% (5 l/min) mixture of oxygen and nitrous oxide.
PDF pan 2446 303. - McGill University Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. If positive-pressure ventilation is to be performed, then moderate intermittent pressure should be applied. GERD: Can certain medications make it worse? Thus, the potential window for safe administration of general anesthesia is frequently very short. Prevention of laryngospasm. In this case, some equipment has high usage demands and becomes scarce throughout the unit. J Anesth 2010; 24:8547, Schroeck H, Fecho K, Abode K, Bailey A: Vocal cord function and bispectral index in pediatric bronchoscopy patients emerging from propofol anesthesia. They can perform an examination and find out if there are ways to prevent laryngospasm from happening in the future.
Pediatr Emerg Care 1990; 6:1089, Woolf RL, Crawford MW, Choo SM: Dose-response of rocuronium bromide in children anesthetized with propofol: A comparison with succinylcholine. Laryngoscope 2006; 116:1397403, Nishino T, Hasegawa R, Ide T, Isono S: Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. Rarely, negative pressure pulmonary edema may occur and requires specific treatment.37The high chest wall to lung compliance ratio observed during infancy, which disappears by the second year of life because of increased chest wall stiffness, may explain why negative pressure pulmonary edema is less frequent in infants than in older children or adults. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australias Northern Territory, Perth and Melbourne. To avoid significant morbidity and mortality, the use of a structured algorithm has been proposed.8,70One study suggests that if correctly applied, a combined core algorithm recommended for the diagnosis and management of laryngospasm would have led to earlier recognition and/or better management in 16% of the cases.70These results should encourage physicians to implement their own structured algorithm for the diagnosis and management of laryngospasm in children in their institutions. Laryngospasm Administer 100% oxygen via nasal mask Suction the oropharynx, hypopharynx, and nasopharynx with a tonsil suction tip Suction/remove all blood, saliva, and foreign material from the oral cavity Pack the surgical site to prevent bleeding into the hypopharynx Draw the tongue and/or mandible forward Review/update the A characteristic crowing noise may be heard in partial laryngospasm but will be absent in complete laryn-gospasm. Muscle relaxants are usually administered when initial steps of laryngospasm treatment have failed to relax the vocal cords. Taking an antacid or acid inhibitor for a few weeks may help diagnose the problem by the process of elimination. Acta Anaesthesiol Scand 1999; 43:10813, Visvanathan T, Kluger MT, Webb RK, Westhorpe RN: Crisis management during anaesthesia: Laryngospasm. Plan A:" 3.5 ETT ready, size 1 Macintosh laryngoscope blade" Small orange Bougie (pre bent), have a size 1 Miller blade available" Have a shoulder roll ready, but I wont put it in place" Have a white guedel airway available if I am having difculty with ventilation" If that doesnt work I will do the 2 person technique" On the other hand, attempts to provide positive-pressure ventilation with a facemask may distend the stomach, increasing the risk of gastric regurgitation. As a result, your airway becomes temporarily blocked, making it difficult to breathe or speak. ANESTHESIOLOGY 2010; 12:98592, McGaghie WC: Medical education research as translational science. Definition. Several studies suggest that deep extubation reduces this incidence, whereas others observed no difference.5,3435In one study, tracheal intubation with deep extubation was associated with increased respiratory adverse events rate (odds ratio = 2.39) compared with LMA removal at a deep level of anesthesia, whereas use of a facemask alone decreased respiratory adverse events (odds ratio = 0.15).35The difference between LMA and ETT was less evident when awake extubation was used (odds ratio = 0.65 and 1.26, respectively). } [Laryngospasm]. Call for help early. Nasal foreign body, ketamine and laryngospasm, Clinical Adjunct Associate Professor at Monash University, Australia and New Zealand Clinician Educator Network, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children (17.4/1,000) than in the general population (8.7/1,000).2,5,,7In fact, the incidence of laryngospasm has been found to range from 1/1,000 up to 20/100 in high-risk surgery (i.e. Experimentally, Oberer et al. To confirm the diagnosis, your healthcare provider may look at your vocal cords with a laryngeal endoscope. Paediatr Anaesth 2008; 18:28996, Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO: Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients. Curr Opin Anaesthesiol 2009; 22:38895, Owen H: Postextubation laryngospasm abolished by doxapram. For instance, coughing can be voluntarily inhibited. Otolaryngol Head Neck Surg 1998; 118:8802, Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO: The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: A preliminary study. Simulation-based Training Scenario Laryngospasm during Induction of General Anesthesia in a 10-month-old Boy. While laryngospasms affect your vocal cords (two bands of tissue housed inside of your larynx), bronchospasms affect your bronchi (the airways that connect your windpipe to your lungs). Copyright 2012, the American Society of Anesthesiologists, Inc. Perianesthetic Management of Laryngospasm in Children, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0b013e318242aae9, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Perianesthetic Dental Injuries : Frequency, Outcomes, and Risk Factors, Understanding the Mechanics of Laryngospasm Is Crucial for Proper Treatment, Fentanyl Does Not Reduce the Incidence of Laryngospasm in Children Anesthetized with Sevoflurane. Even though laryngospasms are scary when they happen, they usually dont cause serious problems. Med Educ 2010; 44:5063, Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ: Value of debriefing during simulated crisis management: Oral, Russo SG, Eich C, Barwing J, Nickel EA, Braun U, Graf BM, Timmermann A: Self-reported changes in attitude and behavior after attending a simulation-aided airway management course. Laryngospasm in amyotrophic lateral sclerosis. Understanding the mechanics of laryngospasm is crucial for proper treatment. Whereas epithelial damage heals in 12 weeks, virus-induced sensitization of bronchial autonomic efferent pathways can last for up to 68 weeks. Eur Respir J 2001; 17:123943, Holm-Knudsen RJ, Rasmussen LS: Paediatric airway management: Basic aspects. Br J Anaesth 2001; 86:21722, Mark LC: Treatment of laryngospasm by digital elevation of tongue (letter). Adapted from Hampson-Evans D, Morgan P, Farrar M: Pediatric laryngospasm.
TeamSTEPPS Instructor Manual: Specialty Scenarios Acta Anaesthesiol Scand 2009; 53:19, Larson CP Jr: Laryngospasmthe best treatment. For laryngeal closure reflex, several types of receptors can be distinguished, according to their specific sensitivities to cold, pressure, laryngeal motion, and chemical agents.19,21The chemoreceptors are sensitive to fluids with low chloride or high potassium concentrations, as well as to strong acidic or alkaline solutions.19,21. Table 2. Both conditions result in sudden, frightening spasms and both conditions can temporarily affect your ability to breathe and speak. Here are a couple of techniques to try during an attack: Because laryngospasm happens suddenly without warning, theres really no way to prevent it. TeamSTEPPS 2.0 Specialty Scenarios - 85 Specialty Scenarios OR Scenario 68 Appropriate for: All Specialties . He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. Acid reflux may cause a few drops of stomach acid backwash to touch the vocal cords, setting off the spasm. In reports addressing respiratory adverse events, including laryngospasm, the overall incidence of perioperative respiratory events as well as the incidence of laryngospasm was higher in 01-yr-old infants in comparison with older children.2,5,,7The risk of perioperative respiratory adverse event was quoted as decreasing by 8% for each increasing year of age.2A recent large cohort study confirmed this inverse relationship between age and risk of perioperative respiratory adverse events.5This study showed that the relative risk for perioperative respiratory adverse events, particularly laryngospasm, decreased by 11% for each yearly increase in age.5. Anesth Analg 2007; 105:34450, Mamie C, Habre W, Delhumeau C, Argiroffo CB, Morabia A: Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. There is controversy in the literature regarding the use of inhalational or IV induction agents and associated risk of laryngospasm. Anaesthesia 1983; 38:3935, Sibai AN, Yamout I: Nitroglycerin relieves laryngospasm. Chris is an Intensivist and ECMO specialist at theAlfred ICU in Melbourne. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. tracheal tug, indrawing), vomiting or desaturation. Identifying patients at increased risk for laryngospasm and taking recommended precautions are the most important measures to prevent laryngospasm (fig. Here are some important features to keep in mind: Complete blockage may present as just apnea; Can be preceded by high-pitched inspiratory stridor, followed by complete airway obstruction Mayo Clinic does not endorse any of the third party products and services advertised. Anesth Analg 1996; 82:7247, Skolnick ET, Vomvolakis MA, Buck KA, Mannino SF, Sun LS: Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. For children with URI, cancellation of elective procedures for a period of 46 weeks was traditionally the rule. 2021; doi: 10.1016/j.jvoice.2020.01.004. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Advertising revenue supports our not-for-profit mission. It may be difficult for a nonspecialist pediatric anesthesiologist to adequately manage an inhalational induction, because of the possibility to fail to manage the airway properly or the inability to recognize and treat early a stridor/laryngospasm. The next line of therapy would be to administer a low dose of succinylcholine (10Y20 mg) to relax the . This content does not have an English version. If you or someone youre with is having a laryngospasm, you should: In addition to the techniques outlined above, there are breathing exercises that can help you through a laryngospasm. The treatment includes opening and clearing the oropharynx, applying CPAP with 100% oxygen, followed by deepening of anaesthesia usually with an i.v . Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea. He is on the Board of Directors for theIntensive Care Foundationand is a First Part Examiner for theCollege of Intensive Care Medicine.
Laryngospasm mechanism - OpenAnesthesia Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. If these medications help, please consult your doctor before taking them long term. Use of suxamethonium without intravenous access for severe laryngospasm.
Laryngospasm: Treatment, Definition, Symptoms & Causes - Cleveland Clinic URI = upper respiratory tract infection.
PDF Airway Management: Use of Succinylcholine or Rocuronium Because these symptoms can be frightening, it is good to have a clear medical plan for prevention and treatment if you have any of these symptoms. , the overall incidence of respiratory adverse events seems to be higher in children who were awake when their LMA was removed and lower in those who were awake when their endotracheal tube was removed.5In summary, evidence seems to favor deep LMA and awake ETT removal. width: auto; ANESTHESIOLOGY 2005; 103:11428, Patel RI, Hannallah RS, Norden J, Casey WF, Verghese ST: Emergence airway complications in children: A comparison of tracheal extubation in awake and deeply anesthetized patients. Their motoneurons are located in the brainstem nucleus ambiguous and the adjacent nucleus retroambigualis. Can J Anaesth 2010; 57:74550, Sanikop C, Bhat S: Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries. Despite a jaw thrust maneuver, positive pressure ventilation with 100% O2, and administration of two bolus doses (5 mg) of IV propofol (0.6 mg/kg), the obstruction was not relieved and SpO2decreased to 52%. The vocal cords are two fibrous bands inside the voice box (larynx) at the top of the windpipe (trachea). Undefined cookies are those that are being analyzed and have not been classified into a category as yet. Risk Factors Associated with Perioperative Laryngospasm, Young age is one of the most important risk factors. } The anesthesiologist assesses that the head/neck could be placed in a more ideal position . These are the reasons why inhalational induction conducted by nonspecialized anesthetists remains associated with an increased risk of laryngospasm.2,5,18In children with hyperactive airways, there are now several arguments in favor of IV induction with propofol versus inhalational induction. 1. Qual Saf Health Care 2005; 14:e3, Fernandez E, Williams DG: Training and the European Working Time Directive: A 7 year review of paediatric anaesthetic trainee caseload data. Even though laryngospasm isnt usually serious or life-threatening, the experience can be terrifying. Many methods and techniques of airway manipulation have been proposed. min-height: 0px; APPENDIX. retained throat pack). This situation creates a risk of bronchopulmonary infection, chronic cough, and bronchospasm. Anesthesiology. To reverse laryngospasm after surgery with anesthesia, your medical team can perform treatments to relax your vocal cords and ease your symptoms. It is mandatory to procure user consent prior to running these cookies on your website. ,5emergent procedures had a moderately higher risk than elective procedures for perioperative respiratory adverse events, including laryngospasm (17%vs. If we combine this information with your protected The vocal cords are two fibrous bands inside the voice box (larynx) at the top of the windpipe (trachea). Unfortunately, laryngospasms usually happen quickly. Perianesthetic Management of Hypertrophic Cardiomyopathy, Copyright 2023 American Society of Anesthesiologists.
PDF TeamSTEPPS Specialty Scenarios: OR - Agency for Healthcare Research and Am J Med 2001; 111(Suppl 8A):69S77S, Shannon R, Baekey DM, Morris KF, Lindsey BG: Brainstem respiratory networks and cough.
Case Scenario Perianesthetic Management of Laryngospasm In Laryngospasm may not be obvious it may present as increased work of breathing (e.g. Avoid breathing in through your nose. Laryngospasm can sometimes occur after an endotracheal tube is removed from the throat. All rights reserved.
Laryngospasm: Causes, Treatment, First Aid, and More - Healthline Although described in the conscious state and associated with silent reflux, laryngospasm is a problematic reflex which occurs often under general anaesthesia. Sometimes, laryngospasm happens for seemingly no reason. The brainstem nucleus tractus solitarius is not only an afferent portal, but has interneurons that play an essential role in the genesis of upper airway reflexes.19Little is known about the centers that regulate and program these reflexes. Drowning is an international public health problem that has been complicated by . Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Because laryngospasm is a potential life-threatening postoperative event, the PACU nurse background: #fff; Paediatr Anaesth 2002; 12:1405, Plaud B, Meretoja O, Hofmockel R, Raft J, Stoddart PA, van Kuijk JH, Hermens Y, Mirakhur RK: Reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. The . Based on a work athttps://litfl.com. The first step of laryngospasm management is prevention. #mc-embedded-subscribe-form .mc_fieldset { Place a straw in your mouth and seal your lips around it. Broaddus VC, et al. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Laryngospasms are rare and typically last for fewer than 60 seconds.
display: inline; These cookies do not store any personal information. Paediatr Anaesth 2008; 18:297302, Cohen MM, Cameron CB: Should you cancel the operation when a child has an upper respiratory tract infection? Accessed Nov. 5, 2021.
Laryngospasm: Causes, symptoms, and treatments - Medical News Today The exercise is then followed by a debriefing session during which constructive feedback is provided. Anesthesiology. Anaesthesia 1998; 53:91720, Ko C, Kocaman F, Aygen E, Ozdem C, Ceki A: The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. In contrast, results from studies in children with recent URIs have shown that LMA was associated with an increased occurrence of laryngospasm.28,32In a recent, large, prospective study, the incidence of laryngospasm was increased after direct stimulation of the upper airway by both LMA and ETT in comparison with a facemask.5Therefore, LMA may be considered more stimulating than the facemask but certainly less than the ETT. The afferent nerves include the trigeminal nerve for the nasopharynx, the glossopharyngeal nerve for the oropharynx and hypopharynx, the superior and recurrent laryngeal nerves, and both branches of the vagus nerve, for the larynx and trachea. A new episode of laryngospasm was immediately suspected. Among all upper airway reflexes, it is the most resistant to deepening anesthesia, whereas the coughing reflex is the most sensitive. border: none; Paediatr Anaesth 2004; 14:21824, Alalami AA, Ayoub CM, Baraka AS: Laryngospasm: Review of different prevention and treatment modalities. The SimBaby simulator represents a 9-month-old pediatric patient and provides a highly realistic manikin that meets specific learning objectives focusing on initial assessment and treatment. IV line insertion should also be delayed until deep anesthesia (regular ventilation with large tidal volume, eyeballs fixed with pupils centered in myosis or moderately dilated) is achieved. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. Thereafter, surgery was quickly completed, while tracheal extubation and postoperative recovery were uneventful. The laryngospasm abates, and the patient becomes easier to ventilate. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. These interventions include removal of the irritant stimulus,8,38chin lift, jaw thrust,39continuous positive airway pressure (CPAP), and positive pressure ventilation with a facemask and 100% O2.3,40,,43These maneuvers are popular because they have been shown to improve the patency of the upper airway in case of airway obstruction.42,4445Less commonly used airway maneuvers, such as pressure in the laryngospasm notch4,44and digital elevation of the tongue46also have been proposed as rapid and effective methods.8Overall conflicting results have been obtained regarding the best maneuver to relieve airway obstruction in children with laryngospasm. If you think youve experienced laryngospasm, talk to your healthcare provider. More children who developed laryngospasm were successfully treated with chest compression (73.9%) compared with those managed with the standard method (38.4%; P< 0.001). PEEP! font: 14px Helvetica, Arial, sans-serif; The patient is unconscious and initially breathing easily with an oral airway in place. PERIOPERATIVE laryngospasm is an anesthetic emergency that is still responsible for significant morbidity and mortality in pediatric patients.1It is a relatively frequent complication that occurs with varying frequency dependent on multiple factors.2,,5Once the diagnosis has been made, the main goals are identifying and removing the offending stimulus, applying airway maneuvers to open the airway, and administering anesthetic agents if the obstruction is not relieved. Designing an effective simulation scenario requires careful planning and can be broken into several steps. 2009 Jul-Aug;59(4):487-95. Review. Manipulation of the airway at an insufficient depth of anesthesia is a major cause of laryngospasm. Furthermore, the efficacy of propofol to break complete laryngospasm when bradycardia is present has been questioned.4In our case, two bolus doses of 5 mg IV propofol (each representing a dose of 0.6 mg/kg) were administered but did not relieve airway obstruction. It is most commonly occurring on induction or emergence phases and can have serious life threatening consequences. Anesth Analg 1991; 73:26670, Rachel Homer J, Elwood T, Peterson D, Rampersad S: Risk factors for adverse events in children with colds emerging from anesthesia: A logistic regression. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis.3,5,7In both partial and complete laryngospasm, signs of varying degrees of airway obstruction, such as suprasternal retraction, supraclavicular retractions, tracheal tug, paradoxical chest, and abdominal movements may be seen.3In addition, inspiratory stridor may be heard in partial laryngospasm but is absent in complete spasm. Von Ungern-Sternberg et al. For example, if laryngospasms are linked to GERD, then treating chronic acid reflux can also reduce your risk for laryngospasm. and bronchomotor reflexes, indicating that not only skeletal but also smooth muscles are involved in upper airway reflexes.19.
Case Scenario: Acute Postoperative Negative Pressure Pulmonary Edema Shortness of breath. Keech BM, et al. At 11:23 PM, an inspiratory stridulous noise was noted again. He is also a Clinical Adjunct Associate Professor at Monash University. #mergeRow-gdpr fieldset label { To provide you with the most relevant and helpful information, and understand which can occur spontaneously, most commonly associated with extubation or ENT procedures, extubation especially children with URTI symptoms, intubation and airway manipulation (especially if insufficiently sedated), drugs e.g. In children, an artificial cough maneuver, including a single lung inflation maneuver with 100% O2immediately before removal of the ETT, is useful at the time of extubation because it delays or prevents desaturation in the first 5 min after extubation in comparison with a suctioning procedure.36Although not demonstrated in this study, this technique could reduce laryngospasm because when the endotracheal tube leaves the trachea, the air escapes in a forceful expiration that removes residual secretions from the larynx. He had been fasting for the past 6 h. Preoperative evaluation was normal (systemic blood pressure 85/50 mmHg, heart rate 115 beats/min, pulse oximetry [SpO2] 99% on room air). He is one of the founders of theFOAMmovement (Free Open-Access Medical education) and is co-creator oflitfl.com,theRAGE podcast, theResuscitologycourse, and theSMACCconference.
SimBaby - Laerdal Medical ANESTHESIOLOGY 2001; 95:103940, Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL: Dose response to intramuscular succinylcholine in children. ANESTHESIOLOGY 2001; 95:299306, Lakshmipathy N, Bokesch PM, Cowen DE, Lisman SR, Schmid CH: Environmental tobacco smoke: A risk factor for pediatric laryngospasm. The purpose of this case scenario is to highlight keypoints essential for the prevention, diagnosis, and treatmentof laryngospasm occurring during anesthesia. (Staff Anesthesiologist, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland), and Jos-Manuel Garcia (Technical Coordinator, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals) for their contribution in the video of the simulated scenario. Such a conservative attitude has already been proposed for otolaryngology patients, whose surgery is expected to have an effect on the recurrence of URI episodes.11Premedication with anticholinergic agents may decrease secretions but has no demonstrated influence on the incidence of laryngospasm.7,29. Br J Anaesth 1998; 81:6925, Krodel DJ, Bittner EA, Abdulnour R, Brown R, Eikermann M: Case scenario: Acute postoperative negative pressure pulmonary edema. A laryngospasm is a muscle spasm in the vocal cords that can lead to problems with speaking and breathing. The video and the script are intended to illustrate the proper application of the management algorithm, to illustrate the technical and the nontechnical skills required in clinical practice, and to be a resource for the readers who wish to develop their own training sessions. Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review. Anaesthesia 2008; 63:3649, Bruppacher HR, Alam SK, LeBlanc VR, Latter D, Naik VN, Savoldelli GL, Mazer CD, Kurrek MM, Joo HS: Simulation-based training improves physicians' performance in patient care in high-stakes clinical setting of cardiac surgery.