Ultrasound-Guided Bilateral Superior Laryngeal Nerve Block for Laryngospasm Prophylaxis in a Child with COVID-19: A Clinical Case Report

Abstract

Laryngospasm is a constant worry in pediatric anesthesia, especially when dealing with children who have active or recent upper airway infections. The internal branch of the superior laryngeal nerve (SLN) is the primary sensory pathway for the supraglottis and triggers the glottic closure reflex. We report on the case of a 3-year-old girl, ASA I, scheduled for tympanostomy while testing positive for SARS-CoV-2. Because of her high risk for respiratory complications, we performed a prophylactic ultrasound-guided bilateral SLN block at the end of the surgery using 1.5 mL of 1% lidocaine on each side. The patient woke up and was extubated without any coughing, desaturation, or laryngospasm. While SLN blocks are usually meant for awake intubations, this case suggests that using the block for prophylaxis could be a helpful strategy for reflex control in high-risk children. We believe these findings are suggestive observations that need further validation through controlled studies to confirm safety and efficacy in pediatrics.