**6. Laryngospasm**

The traditional crowing sound of incompletely closed vocal cords is rarely seen with "Goldilocks" anesthesia. The type of laryngospasm is characterized by complete vocal cord closure. The only prodrome is a cough or a sneeze. The **traditional remedies** of anterior jaw thrust and positive pressure ventilation are **ineffective** in dealing with ketamine-associated laryngospasm. The author has consistently been successful treating this type of laryngospasm with IV lidocaine 1 mg/lb or 2 mg/kg given STAT whenever a cough or sneeze is observed.

Spontaneous ventilation preservation is a hallmark of successful "Goldilocks" anesthesia. The use of succinylcholine (SCh) will produce a patient with very painful postoperative muscle pains. SCh is not recommended as it is an MH trigger as opposed to nontriggering propofol or ketamine. Nondepolarizing rocuronium in small doses is a possibility but also defeats the value of spontaneous ventilation even with its short duration of action. Propofol elevates the lidocaine seizure threshold. The author has not observed lidocaine-induced seizures when treating laryngospasm with IV lidocaine. However, in *extremely* rare cases, severe bradycardia, even asystole, may be seen with multiple IV lidocaine injections. Preemptive lidocaine should be considered optional. Consider deepening propofol level after 2–3 lidocaine doses are required to break the laryngospasm.
