Severe laryngospasm without intravenous access--a case report and literature review of the non-intravenous routes of administration of suxamethonium.

Severe laryngospasm may occur during inhalational induction of paediatric patients. Effective and rapid treatment of this complication is extremely important to prevent severe hypoxia. The treatment of choice is intravenous suxamethonium if muscle relaxation is desired. However, in the absence of intravenous access, alternate routes of administration have to be considered. The rapidity and the effectiveness in treating laryngospasm by these non-intravenous routes are important to the outcome of the patient. Though the intramuscular route may be relatively slower in onset time (time taken to reach maximum effect of paralysis) compared with the intravenous route, clinical experience so far indicates satisfactory result in the treatment of laryngospasm. Current evidences indicate that the intraosseous route is probably superior to the intramuscular route and comparable to the intravenous route in terms of onset time.