Is there a role of a small dose of propofol in the treatment of laryngeal spasm?

Background: Propofol has been found to depress the laryngeal reflexes. We studied whether this property could be utilized to relieve laryngeal spasm. Methods: This study was conducted over a period of 3 years, and included children aged 3-10 years, ASA status I and II. Most of the children were undergoing minor surgical procedures, under general anaesthesia with Laryngeal Mask Airway (LMA™) and caudal epidural analgesia. Results: During this period, 20 patients developed laryngeal spasm on removal of the LMA at the end of surgery. Initially, they all were treated with 100% O₂, with gentle positive pressure ventilation. Out of 20 patients, seven responded well with 100% O₂ and gentle positive pressure ventilation. The remaining 13 were treated with a small dose of propofol (0.8 mg·kg^-1 body weight). Laryngeal spasm was relieved successfully in 10 patients and three patients required intubation to improve their oxygenation. Conclusions: Propofol in a small dose (0.8 mg·kg^-1 body weight) was a useful drug to relieve laryngeal spasm in most children (76.9%) following the removal of the LMA. Because it was not found to be effective in all patients, succinylcholine still has a role to play in critical conditions. However, we recommend propofol as a suitable alternative for relieving laryngeal spasm in situations where succinylcholine is contraindicated.