Penile intracavernosal injection of succinylcholine for laryngospasm management during hypospadias repair

Background Laryngospasm is a serious anesthetic complication that can lead to acute airway obstruction and hypoxemia. Standard management involves deepening anesthesia and administering succinylcholine intravenously (IV) or intramuscularly (IM). However, if IV access is lost or IM drug delivery is too slow, alternative routes are required. We report the first known use of intracavernosal succinylcholine as a rescue intervention for refractory laryngospasm during pediatric hypospadias surgery. Case Presentation A 13‐year‐old obese male undergoing distal hypospadias repair developed persistent laryngospasm with desaturation. Initial IV propofol failed due to a dislodged IV line and IM succinylcholine (4 mg/kg) showed a delayed effect. Consequently, 0.5 mg/kg of succinylcholine was injected directly into the corpus cavernosum to utilize its rich vascular network for rapid absorption. Intracavernosal administration led to near‐immediate relaxation, allowing effective ventilation and oxygenation recovery. The patient was intubated and surgery proceeded uneventfully. No complications occurred at the injection site or systemically, and the patient was discharged without sequelae. Conclusion This case demonstrates intracavernosal succinylcholine as a feasible emergency route when IV access is lost and IM delivery is insufficient. The corpora cavernosa's vascularity enabled rapid drug uptake similar to IV administration. This novel intervention highlights an interdisciplinary approach to airway emergencies and may be considered in extreme scenarios where standard methods fail. Nonetheless, it must be acknowledged that prior IM administration may have contributed to the clinical response, and further investigation is needed to establish the efficacy and safety of this route.