Which port in a storm? Use of suxamethonium without intravenous access for severe laryngospasm

A child with a difficult airway

“…RSI is also performed for the management of the pediatric bleeding tonsil with an incidence of hypoxia of approximately 3% at induction/intubation [34]. A 'controlled' RSI approach in children deemed at high risk of regurgitation and aspiration with deep anesthesia and profound paralysis and with gentle intermittent facemask ventilation appears more appropriate and is supported by the authors of this 'benchmark' study and others [37,38 & ,39].…”

“…Local preferences and resources will determine which muscle relaxant and which route (intramuscular or intraosseous) are used in a child without intravenous access [34,35].…”

Pediatric laryngospasm: prevention and treatment

“…Furthermore, topical lidocaine itself may induce laryngospasm [122]. In another editorial, Walker and Sutton [123] the disadvantage being arrhythmias, the submental dose is 3 mg/kg and the intraosseous dose is the same as the i.v. They claim that obtaining sufficient paralysis for adequate ventilation and oxygenation can be achieved within 60 s by administering succinylcholine via one of the mentioned routes [124,125].…”

Intra-lingual succinylcholine for the treatment of adult laryngospasm in the absence of IV access

“…[12345] With increasing use of propofol and ketamine by non-anesthesia providers and their use in the non-operating room settings, one should be aware of a situation like this and be prepared to treat it. Seeking an IV line especially in patients with difficult IV access could be potentially fatal.…”