laryngospasm and peds Succs dose.

Specialties CRNA

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Can someone please provide me with a pediatric Succs dose for laryngospasm with a respectable reference? I can't seem to find it. I know what normal peds succs doses are and I also know that 2mg/kg IV and 4mg/kg IM should definitely cover it if these doses are enough to intubate with, however I want to see the peds succs larygospasm dose in writing if it is anywhere. All I can find is "treat with Succinnylcholine". Appreciate it....

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succinylcholine 0.5-1.0mg/kg IV. Other pharmacologic options include rocuronium 0.4mg/kg IV or lidocaine 1-1.5mg/kg. This info was found in Morgan & Mikhail in the Pediatric anesthesia chapter.

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Seems to me it was always discussed in ACLS. I've had to give it IM a time or two for peds patients who laryngospasm'd while anesthesia was masking, (pre-intubation, and, therefore, before IV access had been established.) Always worked like a charm, and I was always glad that I remembered from ACLS how to calculate the peds dose (as well as peds dose for atropine.) Maybe we were always just lucky that we had a peds anesthesiologist available to lecture when I took ACLS.

I've never taken PALS, but surely it's discussed in that course.

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where i did my anesthesia peds training they didnt want you to use sux on kids for spasms. their treatment was major positive pressure and time, as hypoxia has a muscle relaxant property when it gets low enough. the few i had to handle would usually break around a sat of 72%. you may need to treat with atropine but not always.

secondly, kids are very parasympathetically invervated so if you do choose to use sux always give atropine with it or you may get significant bradycardia.

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For a laryngospasm 0.1mg/kg is the proper dose. Even with adults 10mg or 20mg will break a spasm and keep your patient breathing.

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Thank you for your responses. Can you reference this somewhere?

For a laryngospasm 0.1mg/kg is the proper dose. Even with adults 10mg or 20mg will break a spasm and keep your patient breathing.
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Take a look in Jaffe third edition (anesthesiologist manual of surgical procedures) Appendix D3 discussing emergence it will give you the dose for laryngospasm 0.1-0.5mg/kg .1 will brak it for an adult and will almost always keep them breathing so you aren't dealing with an apneic patient.

Thank you for your responses. Can you reference this somewhere?
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agree with 0.1mg/kg

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Specializes in Neuro, Anesthesia, CRNA.

We use positive pressure to break the spasm as well. It has worked for me.

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Im an ADN nursing student with a huge interest in this field (anesthesia). In other words, im anesthesia stupid but i love learning about it. Is it a common thing to give a med. to prevent laryngospasm on extubation? because in the few cases i have shadowed i never saw that... or didn't know it if i did see it. And i figured succ would be contraindicated if it was injected shortly before the patient woke up (especially peds.) due to the paralizing effect. I guess that's what sedatives or for. Like i said, i am anesthesia illiterate but any feedback would be awesome!

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Specializes in Anesthesia.
Im an ADN nursing student with a huge interest in this field (anesthesia). In other words, im anesthesia stupid but i love learning about it. Is it a common thing to give a med. to prevent laryngospasm on extubation? because in the few cases i have shadowed i never saw that... or didn't know it if i did see it. And i figured succ would be contraindicated if it was injected shortly before the patient woke up (especially peds.) due to the paralizing effect. I guess that's what sedatives or for. Like i said, i am anesthesia illiterate but any feedback would be awesome!

It's not being given to prevent laryngospasm, but to deal with it if it occurs and isn't broken by positive pressure.

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