A 4-year-old under sevoflurane anaesthesia for ear syringing suddenly develops complete airway obstruction with paradoxical chest movement and falling SpO2. Bag-mask ventilation is difficult. The MOST appropriate immediate step is:

• A Immediate intravenous succinylcholine 2 mg/kg
• B Deepen anaesthesia by increasing sevoflurane concentration
• C Perform awake fibreoptic intubation
• D Administer 100% oxygen with continuous positive airway pressure while removing the stimulus ✓

Explanation

Laryngospasm is managed first by removing the triggering stimulus and applying 100% oxygen with CPAP via a tight-fitting mask, which often breaks partial spasm. Succinylcholine 1 to 2 mg/kg IV is reserved for complete spasm unrelieved by these measures and desaturation, so it is not the first step. Increasing sevoflurane worsens obstruction when ventilation is already compromised, and awake fibreoptic intubation is impractical in a desaturating child.

Reference: Smith's Anesthesia for Infants and Children, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.