Laryngospasm är ett livshotande tillstånd hos barn som kan uppkomma i samband med generell anestesi. Hantering av luftvägen är den mest riskfyllda momentet inom barnanestesi. Syftet med studien var att undersöka vilka riskfaktorer för laryngospasm som finns hos barn vid generell anestesi. Undersökningen genomfördes som en litteraturstudie. Vid analys av fjorton artiklar framkom det i resultatet tre kategorier: anestesirelaterade riskfaktorer, patientrelaterade riskfaktorer och kirurgi-och procedur- relaterade riskfaktorer. Vid anestesirelateraderiskfaktorer framkom det fyra subkategorier; Stadier under anestesi där laryngospasm uppkommer och där är induktion en riskfaktor i denna subkategori. Den andra subkategorin handlar om utrustning för säkerställande av luftvägar där användandet av larynxmask är den största riskfaktorn. Tredje subkategorin behandlar anestesiläkemedel som risk för laryngospasm. Den mest betydande riskfaktorn är inhalationsanestesi. Den fjärde och sista subkategorin är anestesiologens erfarenhet och skicklighet. Det är viktigt att anestesipersonal har rutiner och riktlinjer för hur de skall identifiera, förebygga och behandla laryngospasm. Vidare är det av betydelse att erfaren anestesipersonal finns tillgänglig under hela anestesiförloppet när det föreligger risk för laryngospasm. / Laryngospasm is a life-threatening condition in children that may arise in connection with the anesthesia. Management of the airway is the most critical moment during anesthesia in children. The aim of the study was to investigate the risk factors for laryngospasm during general anesthesia. The survey was    carried out as a literature review. The analyses of the fourteen articles resulted in three categories: anesthesia- related risk factors, patient-related risk factors and surgery-and procedure related risk factors. From the anesthesia-related risk factors revealed four subcategories; Stages during anesthesia where laryngospasm occurs and where induction is a risk factor in this subcategory. The second subcategory is about device for securing the airway which the use of larynx masks is the greatest risk factor. The third subcategory considering the risk of anesthesia drugs risk in laryngospasm. The most significant risk factor here is inhalation anaesthesia. The fourth subcategory is the anesthesiologist experience and skill. It is important that anesthesia professionals have routines and guidelines to identify, prevent and treat laryngospasm. Furthermore, it is important that experienced anaesthesia staff is available throughout the anesthetic process when there is a risk of laryngospasm.

Background: Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children. Material and Methods: The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case-control study. Results: No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P = 0.022) and the presence of an airway anomaly (OR = 3.35, P = 0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly (P = 0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls (P = 0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort. Conclusions: In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.

<div> <div> <div> <p>People with epilepsy have an increased risk of mortality when compared to the general population. These increased mortality risks include deaths related to status epilepticus and sudden unexpected death in epilepsy (SUDEP). Physiological data describing cardiac, respiratory, and brain function prior to sudden death in epilepsy is crucial to the studying the underlying mechanisms behind these deaths. Because it is unknown when sudden deaths in epilepsy may occur, continuous monitoring is necessary to guarantee the capture of physiological data prior to death. </p> <p>I have used custom designed implantable devices to continuously measure cardiac, respiratory, and neurological signals in freely behaving rats with chronically induced epilepsy. Due to the continuous respiration measurements, the resultant dataset is the first of its kind. This dataset indicates that respiratory abnormalities (reduced respiration and short apneas) occur during and after seizures. These abnormalities may indicate SUDEP onset because obstructive apneas due to laryngospasm have been indicated as possible causes of SUDEP in other studies. </p> <p>Laryngospasms can be caused by gastric acid coming into contact with the larynx. During a laryngospasm, intrinsic laryngeal muscles contract, resulting in the closure of the airway. Recently published research has indicated that acid reflux may be responsible for triggering fatal laryngospasms in rats with induced seizures. I have found that the larynx can be opened during a laryngospasm by electrically stimulating the recurrent laryngeal nerves. I have also found that performing gastric vagotomies leads to a statistically significant reduction in mortality due to fatal apneas in rats with induced seizures. </p> </div> </div> </div>

Introducción: La fibrobroncoscopia es un procedimiento útil para el diagnóstico y tratamiento de problemas respiratorios, sin embargo, los niños tienen características anatómicas y fisiológicas que los hacen más susceptibles a complicaciones asociadas al mismo. Objetivo: Evaluar los factores asociados a complicaciones del procedimiento de fibrobroncoscopia en niños y adolescentes del Instituto Nacional de Salud del Niño San Borja. Métodos: Estudio analítico transversal a partir de una base de datos del servicio de neumología del Instituto Nacional de Salud del Niño San Borja durante el periodo junio 2018 – 2019.| Resultados: Se evaluaron 135 pacientes, de los cuales 25.9% (n=35) presentaron complicaciones asociadas al procedimiento y todas estas fueron menores. El 58.2% de los pacientes fueron varones, el 64.4% eran menores de 2 años, el 25.2% entre 2 a 5 años y un 10.4% entre 6 a 10 años. La tercera parte tenía una cardiopatía congénita. En el análisis bivariado, las complicaciones del procedimiento de fibrobroncoscopía se asociaron con el motivo de fibrobroncoscopia (p=0.002). Los pacientes con cardiopatía cianótica tuvieron cinco veces más prevalencia de complicaciones asociadas a fibrobroncoscopia luego de ajustar por variables confusoras (RP: 5.27, IC 95%: 2.29 – 12.13, p<0.05). Los pacientes que se realizaron una FB para estudio microbiológico tuvieron 2 veces más prevalencia de de complicaciones a comparación de los pacientes que se realizaron el procedimiento por otros motivos (RP: 2.92, IC 95%: 1.46 – 5.84, p<0.05). Conclusiones: Las complicaciones de la fibrobroncoscopia en niños y adolescentes son poco frecuentes y son menores. Los pacientes con cardiopatía cianótica y estudio microbiológico como motivo de fibrobroncoscopia presentan mayor prevalencia de complicaciones asociadas a este procedimiento. / Introduction: Fiberoptic bronchoscopy is a useful procedure for diagnosis and treatment of respiratory problems, however, children have anatomical and physiological characteristics that make them more susceptible to complications related to the procedure. Objective: Evaluate the factors associated with complications of the fiberoptic bronchoscopy procedure in children and teenagers. Methods: Cross-sectional analytical study based on a database of the National Institute of Child Health during the period of June 2018 - 2019. Results: Data from 135 patients were analyzed. 25.9% (n=35) presented complications associated with the procedure. 58.2% of the patients were male, 64.4% were younger than 2 years old, 25.2% between 2 and 5 years old, and 10.4% between 6 and 10 years old. The third part had a congenital heart disease. In the bivariate analysis, complications of the fiberoptic bronchoscopy procedure were associated with the reason for fiberoptic bronchoscopy (p=0.002). Patients with cyanotic heart disease have five times more prevalence of complications associated with fiberoptic bronchoscopy after adjusting for confounding variables (RP: 5.27, 95% CI: 2.29 – 12.13, p<0.05). Patients with microbiological study have two times more prevalence of complications compared to patients who underwent the procedure for other reasons (RP: 2.92, 95% CI: 1.46 – 5.84, p<0.05). Conclusions: Patients with cyanotic heart disease and a microbiological study as a reason for fiberoptic bronchoscopy have a higher prevalence of complications associated with this procedure. / Tesis