9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. The authors also thank Frank Schneider (Editing Coordinator, Division of Communication and Marketing of the Geneva University Hospitals, Geneva University Hospitals) and Justine Giliberto (Editing, Division of Communication and Marketing of the Geneva University Hospitals) for editing the video material. These are usually rare events and recurrence is uncommon, but if it happens, try to relax. A laryngospasm is a muscle spasm in the vocal cords that can lead to problems with speaking and breathing. Laryngospasm (luh-RING-o-spaz-um) is a condition in which your vocal cords suddenly spasm (involuntarily contract or seize). During the exercise, the instructor can observe and measure the performance of the trainees and compare them with the standards of performance mentioned in the algorithms. Am J Med 2001; 111(Suppl 8A):69S77S, Shannon R, Baekey DM, Morris KF, Lindsey BG: Brainstem respiratory networks and cough. Anesth Analg 1985; 64:11936, Lee CK, Chien TJ, Hsu JC, Yang CY, Hsiao JM, Huang YR, Chang CL: The effect of acupuncture on the incidence of postextubation laryngospasm in children. 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. 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. Anesthesiology. Nov. 7, 2021. He is one of the founders of theFOAMmovement (Free Open-Access Medical education) and is co-creator oflitfl.com,theRAGE podcast, theResuscitologycourse, and theSMACCconference. Laryngospasm is a frightening condition that happens when your vocal cords suddenly seize up, making breathing more difficult. Lancet 2010; 376:77383, Murat I, Constant I, Maud'huy H: Perioperative anaesthetic morbidity in children: A database of 24,165 anaesthetics over a 30-month period. As your vocal cords slowly relax and open, you may hear a high-pitched sound (stridor). Anaesthesia 1982; 37:11124, Postextubation laryngospasm. 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. (https://pubmed.ncbi.nlm.nih.gov/34817079/), Visitation, mask requirements and COVID-19 information, chronic obstructive pulmonary disease (COPD). If youve experienced a laryngospasm, schedule an appointment with your healthcare provider. Common triggers of reflex laryngeal response during anesthesia are secretions, blood, insertion of an oropharyngeal airway suction catheter, and laryngoscopy. 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. Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea. Breathe in slowly through your nose. No chest wall movement with no breath sounds on auscultation, Inability to manually ventilate with bag-mask ventilation, ischemic end organ injury (e.g. If we combine this information with your protected This scenario illustrates the potential risks of not managing your resources properly. Review/update the Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. This function involves several upper airway reflexes: the laryngeal closure reflex, which consists of vocal fold adduction; apnea; swallowing; and coughing.19To efficiently protect the airway, laryngeal closure reflex must be coordinated with swallowing. ANESTHESIOLOGY 2007; 107:7149, Tait AR, Burke C, Voepel-Lewis T, Chiravuri D, Wagner D, Malviya S: Glycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections. Laryngospasm may not be obvious it may present as increased work of breathing (e.g. It should be suspected whenever airway obstruction occurs, particularly in the absence of an obvious supraglottic cause. You might experience multiple laryngospasms in a brief time but in most cases, each episode ends after about a minute. include protected health information. If breathing exercises and pushing on your laryngospasm notch dont relieve your symptoms, call 911 or head to the nearest emergency room. Therefore, the injection of IV succinylcholine was required to treat this persistent laryngospasm. If IV access cannot be established in emergency, succinylcholine may be given by an alternative route.5354Intramuscular succinylcholine has been recommended at doses ranging from 1.5 to 4 mg/kg.53The main drawback of intramuscular administration is the slow onset in comparison with the IV route. Accessed Nov. 5, 2021. A computer-aided incidence study in 136,929 patients Acta Anaesthesiol Scand 1984; 28:56775, Burgoyne LL, Anghelescu DL: Intervention steps for treating laryngospasm in pediatric patients. For example, if laryngospasms are linked to GERD, then treating chronic acid reflux can also reduce your risk for laryngospasm. Experimentally, Oberer et al. #mergeRow-gdpr { There is controversy in the literature regarding the use of inhalational or IV induction agents and associated risk of laryngospasm. PubMed PMID: Orliaguet GA, Gall O, Savoldelli GL, Couloigner V. Case scenario: perianesthetic management of laryngospasm in children. Also find out about . They can help figure out whats causing them. In the case of laryngospasm, basic appropriate airway manipulations such as chin lift, jaw thrust, and oral airway insertion in combination with CPAP can be demonstrated and practiced with these models. The vocal cords are two fibrous bands inside the voice box (larynx) at the top of the windpipe (trachea). This site uses Akismet to reduce spam. Avoid breathing in through your nose. If you are a Mayo Clinic patient, this could This paper discusses a case study where the patient had laryngospasm, it also looks at the pathophysiology, risk factors and management of . His one great achievement is being the father of three amazing children. ANESTHESIOLOGY 1956; 17:56977, Crawford MW, Rohan D, Macgowan CK, Yoo SJ, Macpherson BA: Effect of propofol anesthesia and continuous positive airway pressure on upper airway size and configuration in infants. Anaesthesia 1983; 38:3935, Sibai AN, Yamout I: Nitroglycerin relieves laryngospasm. acute dystonic reactions; rarely associated with ketamine procedural sedation. Laryngospasm scenario. Principal effectors are respiratory muscles (diaphragm, intercostals, abdominals, and upper airway). Anesthesiology. Realistic training with high-fidelity mannequins and other types of simulations represent unique educational tools that can be fully integrated in a residency program based on competency.72Similarly, simulation-based education is being increasingly used for continuing medical education. 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. For example, you might be able to exhale and cough, but have difficulty breathing in. Jun 2005;14(3):e3. , 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. Qual Saf Health Care. The onset of a vocal cord spasm is sudden, and just as suddenly, it goes away, usually after a few minutes. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. 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. 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. scenario #2: the non-crashing epiglottitis patient. GillesA. Orliaguet, Olivier Gall, GeorgesL. Savoldelli, Vincent Couloigner, Bruno Riou; Case Scenario: Perianesthetic Management of Laryngospasm in Children. Two min after loss of eyelash reflex, a first episode of airway obstruction with inspiratory stridor and suprasternal retraction was successfully managed by jaw thrust and manual positive pressure ventilation. However, waiting until hypoxia opens the airway is not recommended, because a postobstruction pulmonary edema or even cardiac arrest may occur.43. More needed than oxygen! 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. Int J Pediatr Otorhinolaryngol 2010; 74:4868, Al-alami AA, Zestos MM, Baraka AS: Pediatric laryngospasm: Prevention and treatment. Jpn J Physiol 2000; 50:314, Thompson DM, Rutter MJ, Rudolph CD, Willging JP, Cotton RT: Altered laryngeal sensation: A potential cause of apnea of infancy. information is beneficial, we may combine your email and website usage information with ANESTHESIOLOGY 1981; 55:599602, Walker RW, Sutton RS: Which port in a storm? Shortness of breath. The mother volunteered that he was exposed to passive smoking in the home. 21,22. . However, children younger than 3 yr may develop 510 URI episodes per year. Among all upper airway reflexes, it is the most resistant to deepening anesthesia, whereas the coughing reflex is the most sensitive. Epidemiology of Laryngospasm in Pediatric Patients Children are more prone to laryngospasm than adults, with laryngospasm being reported more commonly in children 1,000).2,5-7 In fact, the incidence of laryngospasm has been gery (i.e., otolaryngology surgery).2,5-7 Many factors may increase the risk of laryngospasm. He is retaining oxygen saturations > 94 percent. Recently, a new technique with gentle chest compression has been proposed as an alternative to standard practice for relief of laryngospasm.47In this before-after study, extubation laryngospasm was managed with standard practice (CPAP and gentle positive pressure ventilation via a tight-fitting facemask with 100% O2via facemask) during the first 2 yr of the study, whereas in the following 2 yr, laryngospasm was managed with 100% O2and concurrent gentle chest compression. Khanna S (expert opinion). Muscles involved: lateral cricoarytenoid, thyroarytenoids (both from recurrent laryngeal), crycrothyroid (from external branch of superior laryngeal). Ann Otol Rhinol Laryngol 2005; 114:25863, Thach BT: Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life. Laryngospasm. Laryngospasm was treated by 50 mg propofol and manual positive pressure mask ventilation with 100% inspired oxygen. Airway management training, including management of laryngospasm, is an area that can significantly benefit from the use of simulators and simulation.73These tools represent alternative nonclinical training modalities and offer many advantages: individuals and teams can acquire and hone their technical and nontechnical skills without exposing patients to unnecessary risks; training and teaching can be standardized, scheduled, and repeated at regular intervals; and trainees' performances can be evaluated by an instructor who can provide constructive feedback, a critical component of learning through simulation.7475. To provide you with the most relevant and helpful information, and understand which This means that if nothing has occurred 46 h after the occurrence of a laryngospasm it is likely that the course will be uneventful. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. These preliminary results are interesting and need to be confirmed by further studies. SimBaby is a tetherless simulator designed to help healthcare providers effectively recognize and respond to critically ill pediatric patients. Paediatr Anaesth 2008; 18:297302, Cohen MM, Cameron CB: Should you cancel the operation when a child has an upper respiratory tract infection? Laryngospasm is a rare but frightening experience. Acta Anaesthesiol Scand 1999; 43:10813, Visvanathan T, Kluger MT, Webb RK, Westhorpe RN: Crisis management during anaesthesia: Laryngospasm. Singapore Med J 1998; 39:32830, Warner DO: Intramuscular succinylcholine and laryngospasm. For children with URI, cancellation of elective procedures for a period of 46 weeks was traditionally the rule. We decided to omit it in the preventive and/or treatment algorithms of laryngospasm, although other authors have included it.3,8,66. Anesthesia was then maintained by facemask with 2.0% expired sevoflurane in a mixture of oxygen and nitrous oxide 50/50%. Case Scenario Perianesthetic Management of Laryngospasm In; Hazard Identification and Risk Assessment; Permit to Work Ensuring a Safe Work Environment Introduction Industrial Workers Face Many Hazards in Their Daily Routines; Health Surveillance Employer's Pack; Incidence and Associated Factors of Laryngospasm Among Pediatric Only sevoflurane or halothane should be used for inhalational induction. It occurs during general or local anesthesia, natural sleep (rapid eye movement phase of sleep), hypercapnia, and hypoxia, as well as various muscular, neuromuscular junction, or peripheral nerves disorders affecting the efferent neural pathway and effector organs of upper airway reflexes.19, This condition arises as a result of an exaggerated and prolonged laryngeal closure reflex that can be triggered by mechanical (manipulation of pharynx or larynx) or chemical stimuli (e.g. 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%. Description The patient requires intubation, but isn't actively crashing. According to Phil Larson: This notch is behind the lobule of the pinna of each ear. Anaesthesia 2007; 62:7579, Tobias JD, Nichols DG: Intraosseous succinylcholine for orotracheal intubation. They can perform an examination and find out if there are ways to prevent laryngospasm from happening in the future. It normally passes quickly and is not dangerous, but some . Our providers specialize in head and neck surgery and oncology; facial plastic and reconstructive surgery; comprehensive otolaryngology; laryngology; otology, neurotology and lateral skull base disorders; pediatric otolaryngology; rhinology, sinus and skull base surgery; surgical sleep; dentistry and oral and maxillofacial surgery; and allied hearing, speech and balance services. To confirm the diagnosis, your healthcare provider may look at your vocal cords with a laryngeal endoscope. 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. The goal is to slow your breathing and allow your vocal cords to relax. In: Anesthesia Secrets. The progressive signs and symptoms are shivering (36C), confusion, disorientation, introversion (35C), amnesia (34C), cardiac arrhythmias (33C), clouding of consciousness (33-30C), LOC (30C), ventricular fibrillation (VF) (28C), and death (25C). Simulation-based Training Scenario Laryngospasm during Induction of General Anesthesia in a 10-month-old Boy. Laryngospasms that are caused by other conditions like asthma, stress or hypersensitivity arent usually dangerous or life-threatening. Mayo Clinic. Manual facemask ventilation became difficult with an increased resistance to insufflation and SpO2dropped rapidly from 98% to 78%, associated with a decrease in heart rate from 115 to 65 beats/min. Manipulation of the airway at an insufficient depth of anesthesia is a major cause of laryngospasm. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. 1. ANESTHESIOLOGY 1997; 87:136872, Mazurek AJ, Rae B, Hann S, Kim JI, Castro B, Cot CJ: Rocuronium, Cheng CA, Aun CS, Gin T: Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children. Thereafter, surgery was quickly completed, while tracheal extubation and postoperative recovery were uneventful. If laryngospasms are due to anxiety, then anti-anxiety meds can help ease your spasms. We also use third-party cookies that help us analyze and understand how you use this website. background: #fff; 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. 5 of 7 This document is not intended to provide a comprehensiv e discussion of each drug. GERD: Can certain medications make it worse? 1998 Nov;89(5):1293-4. 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. information highlighted below and resubmit the form. In the study by von Ungern-Sternberg et al. Difficulty breathing ( dyspnea) Fatigue and exhaustion are other less-common and more subtle symptoms that may be associated with bronchospasm. An IV line was obtained at 11:15 PM, while the child was manually ventilated. Many describe a choking sensation. Place a straw in your mouth and seal your lips around it. width: auto; Attempt airway maneuvers such as jaw thrust and nasal airway. Cleveland Clinic is a non-profit academic medical center. However, a systematic approach based on the model of translational research has recently been proposed in medical education.79In this model, successive rigorous studies are conducted to evaluate the acquisition of skills and knowledge at different outcome levels. Case Scenario: Perianesthetic Management of Laryngospasm in Children Case Scenario: Perianesthetic Management of Laryngospasm in Children Case Scenario: Perianesthetic Management of Laryngospasm in Children Case Scenario: Perianesthetic Management of Laryngospasm in Children Anesthesiology. 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. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. c. Treatment of laryngospasm is aimed at supporting ventilation. Laryngospasm is usually defined as partial or complete airway obstruction associated with increasing abdominal and chest wall efforts to breathe against a closed glottis. 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. The breathing difficulty can be alarming, but it's not life-threatening. If youve had recurring laryngospasms, you should see your healthcare provider to find out whats causing them. Both conditions result in sudden, frightening spasms and both conditions can temporarily affect your ability to breathe and speak. 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). These risk factors can be The use of desflurane during maintenance of anesthesia appeared to be associated with a significant increase in perioperative respiratory adverse events, including laryngospasm, compared with sevoflurane and isoflurane.5Isoflurane appeared to produce laryngeal effects similar to sevoflurane.5. 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. It is not the same as choking. But opting out of some of these cookies may have an effect on your browsing experience. Breathe in and out through the straw without pausing between the inhale and the exhale. #mc-embedded-subscribe-form input[type=checkbox] { Eur Respir J 2001; 17:123943, Holm-Knudsen RJ, Rasmussen LS: Paediatric airway management: Basic aspects. The treatment includes opening and clearing the oropharynx, applying CPAP with 100% oxygen, followed by deepening of anaesthesia usually with an i.v . Although the efficacy of subhypnotic doses of propofol has been suggested in children, there is a possibility that these doses are inadequate in infants, especially in those younger than 1 yr. This content does not have an English version. [. This situation has been found to occur in approximately 50% of patients.8The most commonly used muscle relaxant is succinylcholine, but other agents have also been used, including rocuronium and mivacurium.8However, succinylcholine remains the gold standard.4Some authors have suggested the use of a small dose of succinylcholine (0.1 mg/kg) but there is a lack of dose-response study because the study included only three patients.52Therefore, we recommend using IV doses of succinylcholine no less than 0.5 mg/kg. 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). First, the introduction of working hour limitations in virtually all Western countries has decreased the number of pediatric cases performed by trainees.71Second, most anesthetics given to children are administered by nonspecialists whose lack of experience and inability to maintain their skill set for children is a problem. They can determine the cause of your laryngospasms and recommend an appropriate treatment plan. 2012 Aug;117(2):441-2. doi: 10.1097/ALN.0b013e31825f02b4. Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review. It is a primitive protective airway reflex that exists to . } margin-top: 20px; Anaesthesia 1993; 48:22930, Seah TG, Chin NM: Severe laryngospasm without intravenous accessa case report and literature review of the non-intravenous routes of administration of suxamethonium. stroke, hypoxic encephalopathy), Attempt to break the laryngospasm by applying painful inward and anterior pressure at , If hypoxia supervenes consider administering, Laryngospasm is usually brief and may be followed by a. Exhale through pursed lips. In the recent analysis of 189 reports of laryngospasm to the Australian Incident Monitoring Study, one in three patients suffered significant physiological disturbance. Even though laryngospasm isnt usually serious or life-threatening, the experience can be terrifying. information and will only use or disclose that information as set forth in our notice of So, treatment often involves finding ways to stay calm during the episode. Br J Anaesth 2009; 103:5669, Wong AK: Full scale computer simulators in anesthesia training and evaluation. 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. Past medical history was unremarkable except for an episode of upper respiratory tract infection 4 weeks ago. 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 ANESTHESIOLOGY 2001; 95:103940, Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL: Dose response to intramuscular succinylcholine in children. Curr Opin Anaesthesiol 2009; 22:38895, Owen H: Postextubation laryngospasm abolished by doxapram. A detailed history should be taken to identify the risk factors. This usually occurs because of stimulation during a light plane of anaesthesia but may also occur because of blood, secretions, and foreign bodies (e.g. Advertising revenue supports our not-for-profit mission. For the management of laryngospasm in children, this task is complicated by two facts. Br J Anaesth 2001; 86:21722, Mark LC: Treatment of laryngospasm by digital elevation of tongue (letter). 1. 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. The apneic reflex varies as a function of age. Thus, the potential window for safe administration of general anesthesia is frequently very short. Table 1. Designing an effective simulation scenario requires careful planning and can be broken into several steps. Laryngospasm may be preceded by a high-pitched inspiratory stridor some describe a characteristic crowing noise followed by complete airway obstruction. These risk factors can be patient-, procedure-, and anesthesia-related (table 1). These cookies track visitors across websites and collect information to provide customized ads. Any stimulation in the area supplied by the superior laryngeal nerve, during a light plane of anesthesia, may produce laryngospasm. Mayo Clinic does not endorse any of the third party products and services advertised. 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. Rev Bras Anestesiol. Fig. and bronchomotor reflexes, indicating that not only skeletal but also smooth muscles are involved in upper airway reflexes.19. (Staff Anesthesiologist, Department of Anaesthesia, Children's University Hospital, Dublin, Ireland), for kindly reviewing the manuscript; Hlne Mathey-Doret, M.D. Upper airway disorders. There are data supporting the efficacy of structured courses that integrate airway trainers and high fidelity simulation for airway management training.7677Recent evidence also supports the transfer of technical and nontechnical skills acquired during simulation to the clinical setting.78We therefore strongly encourage the integration of simulation-based training for pediatric airway management, including for the management of laryngospasm.