Laryngeal reflex responses in pediatric anesthesia

Abstract

Laryngeal and respiratory reflexes are vitally important defense mechanisms against foreign body aspiration, safeguarding airway patency, and ventilation. These highly preserved automatisms easily overrule external influences like willpower or (anesthetic) medication. Prevention and anticipation are, therefore, the essential strategies to avoid adverse events and damage, and treatment is most effective in the early stage of the reflex response. The physiology and pathophysiology of the various defensive reflexes as well as a comprehensive anesthetic approach to prevention and treatment are outlined in this review.

Atemwegsmanagement in der Kinderanästhesie

“…Dies wird als Grund für altersgruppentypisch überschießende Reaktionen gesehen [8]. Dabei zeigen viele Frühgeborene bei Manipulationen und auch bei dem Versuch einer Beatmung einen Ausatemspasmus mit verschlossenem Larynx ("das Kind presst sich weg") und rascher sowie teilweise tiefer Entsättigung [9]. Zusätzlich zu beachten ist bei der Beatmung mit einer Maske, bei einer Laryngoskopie oder auch dem Einsetzen einer Larynxmaske (auch seltener bei älteren Kindern): Es kann hier zu einer wahrscheinlich dem trigeminokardialen Reflex zuzuordnenden Bradykardie durch Manipulationen im Versorgungsbereich aller Trigeminusäste kommen [10].…”

Developmental respiratory physiology

“…Laryngeal and respiratory reflex responses (eg, laryngospasm, glottic spasm/closure, expiration reflex, apnea, spasmodic panting, and cough reflex) represent important defensive strategies securing the integrity of lower airways from aspiration of foreign bodies 26 . There is a lack of comprehensive scientific information regarding developmental aspects of these reflex responses in humans.…”

“…Particularly in combination with glottic closure, expiration reflexes can lead to severe hypoxic episodes. 26 Protective reflexes also influence spontaneous breathing in the very young. Particularly in preterm babies, the pressure of a face mask may induce bradycardia and apneas by stimulating stretch receptors of the trigeminal nerve, known as trigemino-cardiac reflex.…”

“…While a cough is a combination of an inspiration and a forceful expiration, expiration reflexes do not include an inspiration. Particularly in combination with glottic closure, expiration reflexes can lead to severe hypoxic episodes 26 …”

Incidence of post-anesthetic respiratory complications in pediatrics. Observational, single-center study in Medellin, Colombia

“…In pediatrics, the incidence of any major complication is described to be as high as 5.2% (5); however an important proportion is considered preventable (7). Most perioperartive complications in the pediatric population have been observed during anesthesia induction and in the PACU (6).…”