I have a question about a common problem that is usually just a nuisance, but occassionally a hindrance.

Hiccups post induction.

Probably 10% of my LMA patients exhibit hiccuping after induction. Usually settles down after a a few minutes. Extra propofol does not seem to obliterate it. And occassionally I have had the hiccups get worse and worse, rather than better and better, to the point where the patient eventually gets stridorous or spasmy (is that an adjective?).

Any ideas on how to minimise it?

My usual anesthetic for spont resp LMAs is midazolam about 1-3mg, fentanyl 25mcg, propofol 120-160mg for the avergae adult.

I trained in the UK and then worked for 1 year in Boston, USA. I was surprised at how different some things were. The most striking difference in clinical practice which I must admit I have not imported back to the UK is the American practice of doing an inhalational induction in a child, then proceding to secure the airway (either with an LMA or ETT) BEFORE obtaining IV access.

Where I trained, this would be grounds for failing the Finals. What would happen (I can hear the examiner ask) if after induction an one attempt at intubation, the child laryngospams before IV access is obtained?

I know the stock answers: children are almost always easy to intubate, IM sux, CPAP.

Is this common practice in the USA? Or was it just a regional variant?