Airway management: escalation of laryngospasm: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Airway management: escalation of laryngospasm

Sample item

During emergence from sevoflurane a child has complete upper airway obstruction with a silent bag and paradoxical chest movement. Despite 100 percent oxygen, CPAP, jaw thrust and a bolus of propofol, SpO2 falls to 78 percent and the heart rate is falling. What is the next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Low-dose intravenous suxamethonium

In persistent laryngospasm with falling saturation after simple manoeuvres and deepening of anaesthesia, a small dose of suxamethonium relaxes the cords and allows ventilation. Atropine is added if bradycardia occurs. Delay risks hypoxic arrest, so escalation should not wait.

Option by option

  • A. Attempt tracheal intubation without a relaxant

    Laryngoscopy without relaxation is difficult and can worsen the spasm.

  • B. Low-dose intravenous suxamethonium (correct)

    Correct. A small dose of a rapid relaxant breaks the spasm when other measures have failed.

  • C. Nebulised adrenaline

    Nebulised adrenaline treats airway oedema, not reflex cord closure, and the child cannot inhale it.

  • D. Wait for the spasm to resolve with continued CPAP

    Waiting risks hypoxic cardiac arrest in a child already bradycardic.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Low-dose intravenous suxamethonium. In persistent laryngospasm with falling saturation after simple manoeuvres and deepening of anaesthesia, a small dose of suxamethonium relaxes the cords and allows ventilation.

Why is "Attempt tracheal intubation without a relaxant" not the answer?

Laryngoscopy without relaxation is difficult and can worsen the spasm.

Why is "Nebulised adrenaline" not the answer?

Nebulised adrenaline treats airway oedema, not reflex cord closure, and the child cannot inhale it.

Why is "Wait for the spasm to resolve with continued CPAP" not the answer?

Waiting risks hypoxic cardiac arrest in a child already bradycardic.

What concept does this question test?

It tests Airway management: escalation of laryngospasm in Anaesthesia. Atropine is added if bradycardia occurs. Delay risks hypoxic arrest, so escalation should not wait.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Airway management: escalation of laryngospasm?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.