Treatment of laryngeal spasm in pediatric anesthesia by retroauricular digital pressure. Case report

Problems with pediatric airways are among the greatest challenges an anesthesiologist can face. Laryngeal spasm, which is twice or three times more frequent in the pediatric population, is paramount. The objective of this work was to report the treatment of laryngeal spasm applying digital pressure on a specific area behind the ear lobe. The technique is old, easy, but little known. It is safe and can be promptly done, and does not require peripheral venous access, which might not be present in some situations. We report two cases of pediatric anesthesia, in a three-year old and six month-old patients, who developed laryngeal spasm. Both patients were treated by applying retroauricular digital pressure with immediate improvement of the breathing pattern and arterial oxygen saturation. Since laryngeal spasm is a common and potentially severe complication due to its morbimortality, it requires a safe, effective, and fast treatment. The classical treatment of laryngeal spasm includes the administration of 100% oxygen with positive pressure per ventilatory unit (balloon and mask) and, in the absence of response, intravenous succinylcholine, 0.25 to 1 mg x kg(-1). The technique presented here for the treatment of laryngeal spasm is easy to perform, safe and effective, and consists of bilateral digital pressure behind the ear lobes, which reversed the laryngeal spasm in a few seconds, avoiding the development of complications.