A prospective cross-sectional observational study of the prevalence and risks for laryngospasm in paediatric patients in four government-funded hospitals in KwaZulu-Natal, South Africa.

Authors

  • Thokozani Zhande Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
  • Larissa Cronjé Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, South Africa
  • Jenna Taylor Laureau Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, South Africa
  • Nobuhle Nkosi Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
  • Chantal Chellan Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
  • Ndumiso Kheswa Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2168

Keywords:

Laryngospasm, Peri-operative respiratory adverse events, Paediatric anaesthesia

Abstract

Background:

Laryngospasm (LS) is a common paediatric anaesthetic respiratory adverse event associated with serious complications if not detected and treated timeously.

 Methods:  

A prospective observational cross-sectional study was conducted from 15 May to 4 August 2023 in four government-funded hospitals in KwaZulu-Natal, South Africa. The primary outcome measure was the prevalence of laryngospasm, and a further aim was to identify associated factors, using binary logistic regression analyses.

 Results:

905 participants were recruited. Mean patient age was 4.2 (SD ± 3.7) years. Most children were ASA physical status I and II (77.7%), presenting for elective surgery. The commonest comorbidity was an ‘airway anomaly’ (12.8%), followed by current or recent upper respiratory tract infection (URTI) in 11.6% of patients. The prevalence of laryngospasm was 10.1% and most occurred at emergence (54.9%). And 69.2% of children with LS had desaturation <91%. Risks independently associated with LS were age (2 to 5 years; adjusted odds ratio [aOR] 2.15, p0.026), an URTI (aOR 2.58, p=0.004), absence of a specialist in theatre (aOR 11.67, p<0.001), inhalational induction (aOR 10.21, p=0.004) or co-induction (aOR 6.34, p=0.020), use of a supraglottic airway device(SGAD) (aOR 2.17, p=0.022), inadequate depth of anaesthesia (aOR 13.98, p<0.001), non-use of neuromuscular blocker (aOR 4.64, p=0.010), and airway (aOR 2.27, p=0.031) and urological surgeries (aOR2.75, p=0.013. No children had a serious complication, although two children were admitted to high care.

 Conclusion:

The prevalence of LS in this study was 10-fold higher than in high-income countries, and the presence of a specialist anaesthetist is protective, indicating the importance of training in the reduction of perioperative critical events in children.

 Recommendations:

Anaesthetists should be aware of the independent risk associated with laryngospasm as identified in this study and ensure such children are managed by a specialist anaesthesiologist.

Author Biographies

Thokozani Zhande, Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

Currently working as a clinical fellow in paediatric anaesthesia at Birmingham Children’s Hospital, United Kingdom. Studied anaesthetics at the University of KwaZulu-Natal, South Africa, where she completed her registrar time and obtained her Fellowship with the College of Anaesthetists (FCA) in 2023.

 

Larissa Cronjé, Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, South Africa

Specialist anaesthesiologist, currently the Head of Department of Anaesthesia and Pain Medicine at the Inkosi Albert Luthuli Hospital, with a special interest in paediatric anaesthesia. She is also a councillor on the College of Anaesthetists of South Africa, with a special portfolio for the development of workplace-based assessments.

Jenna Taylor Laureau, Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, South Africa

Paediatric anaesthetist who was the head of the department of paediatric anaesthesia at Inkosi Albert Luthuli Central Hospital from 2020 to 2024, before relocating to Canada, where she is working at Stollery Children's Hospital in Edmonton, Alberta, Canada.

Nobuhle Nkosi, Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

Registrar in anaesthetics, critical care, and pain at the University of KwaZulu-Natal in South Africa.

Chantal Chellan, Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

Specialist anaesthesiologist in the Department of Anaesthetics, Critical Care and Pain Management at Victoria Mxenge Hospital, Durban, South Africa.

Ndumiso Kheswa, Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

Specialist anaesthesiologist at Harry Gwala Hospital in Pietermaritzburg, Durban, South Africa.

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Published

2025-12-01

How to Cite

Zhande, T., Cronje, L., Taylor Laureau, J., Nkosi, N., Chellan, C., & Kheswa, N. (2025). A prospective cross-sectional observational study of the prevalence and risks for laryngospasm in paediatric patients in four government-funded hospitals in KwaZulu-Natal, South Africa. Student’s Journal of Health Research Africa, 6(12), 14. https://doi.org/10.51168/sjhrafrica.v6i12.2168

Issue

Vol. 6 No. 12 (2025): December 2025 issue

Section

Section of Anesthesia and Surgery Research

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Copyright (c) 2025 Thokozani Zhande, Larissa Cronjé, Jenna Taylor Laureau, Nobuhle Nkosi, Chantal Chellan, Ndumiso Kheswa

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.