Post-extubation laryngeal spasm in children is no longer a nightmare

ABSTRACT

Postextabation laryngeal spasm in children is no longer a nightmare. Laryngospasm in children after extubation is ever happening. Sometimes it is severe and alarming and not easily amenable for treatment and may pose great morbidity. Opioids given prior to noxious stimuli, ameliorates or prevent physiologic responses. This study was conducted to assess safety and efficacy of pethidine on post extubation laryngospasm. Forty children ASA 1 and 11 aged 3-12 years undergoing minor and moderate surgery were included in this study. Approval of ethics committee and parental consent were taken. Standard anesthetic regiemen of fentanyl 1-2Mg/Kg[-1] followed by propofol 2-3mg/Kg[-1] and atracurium 0.5mg/Kg[-1] were used. Maintenence with sevoflurane [end tidal 1.5 MAC]. Patients were ventilated to ETCO2 32mmHg. All patients; were monitored for SaO2, NIBP, EGG and ETCO2. Children were divided into 2 groups; Pethidine group which received pethidine 0.5 mg/ Kg[-1], 10 minutes towards end of surgery. Control group received 5 ml NSS. Children were extubated in recovery position. Any adverse airway events; cough, stridor, breathholding, apnea, desaturation and laryngospasm were recorded. Emergency profile and awakening time were recorded and all results tabulated. Control group showed incidence of cough [25%], stridor [10%] laryngeal spasm [20%] and desaturation [15%] vs only one case of mild cough in pethidine group. Emergence was excellent in 95% in pethidine vs 75% in control Awakening times were groups [5.3, 9.5vs 5.2, 10.2min] in P and C groups. Pethidine prior to extubation almost prevents laryngospasm without undue prolongation of awakening time with overall excellent uneventeful recovery