Clinical Adverse Effects

Vomiting Incidence: 5-10%
  • Treat symptomatically
  • Prophylactic IV Ondansetron will reduce the incidence, but with a NNT 9 (95% CIs 5-36) [9]
  • The dose is 0.1 mg/kg (maximum of 4 mg)
Airway patency problems Incidence: < 1%
  • Apply simple airway manoeuvres
Laryngospasm Incidence: 0.3%
  • If the child develops stridor, attempt airway repositioning, gently try suctioning any secretions and apply a high flow oxygen mask with a reservoir bag
  • If the child is saturating appropriately continue the procedure
  • If the stridor gets worse or the child starts de-saturating, let the child breathe oxygen via a bag-valve-mask. Stop the procedure. Ask for Help.
  • If de-saturation reaches below 92%, start gentle bag-valve-mask ventilation. Apply PEEP, if necessary. Prepare for RSI.
  • If the stridor worsens further, seek help and prepare relevant anaesthetic agent (e.g. suxamethonium) and proceed to RSI.

The reported incidence of laryngospasm requiring intubation is 0.02%. [3]

Learning bites

  • Simple airway manoeuvres will counter most airway problems.
  • The need for suxamethonium in response to airway difficulty is rare, 0.02%.
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