Laryngospasm question

  1. I was wondering if any of the anesthesia providers on this board (CRNAs, SRNAs, MDAs or AAs) have ever seen or used the "digital pressure at the 'laryngospasm notch' technique?" Is it effective?
    I have read about it, but was wondering if it is often used in practice? I have been taught the 'gold standards' of laryngospasm treatment but this technique was not talked about. TIA.
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  2. 10 Comments

  3. by   zrmorgan
    Morgan and Mikhail discusses it a bit (pg 78-79). Saw it used once in the icu. I think it did more to jack the patients sympathetic response then having any laryngo-relaxation effect. It may be convenient anyway, since your hands are probably there to begin with. Dont know if it would be problematic in hypertensive situations. I imagine the "spock" trapezius grab might elicit a similar response without supporting the airway lol. Nonetheless, it broke the spasm without use of succs etc.
  4. by   yoga crna
    What and where is the laryngospasm notch?

    I like to pull up at the angles of the jaw to stimulate the patient, which may or may not help with the spasm. Positive pressure ventilation with high pressure on the bag is also effective. My last choice is a very small dose of succinylcholine (5-10 mg). Learning to extubate at the right time is a good way to prevent the spasm.

    Yoga
  5. by   jwk
    Quote from yoga crna
    What and where is the laryngospasm notch?

    I like to pull up at the angles of the jaw to stimulate the patient, which may or may not help with the spasm. Positive pressure ventilation with high pressure on the bag is also effective. My last choice is a very small dose of succinylcholine (5-10 mg). Learning to extubate at the right time is a good way to prevent the spasm.

    Yoga
    Amen to extubating at the right time. Extubate deep, or awake - the "in between" is where you'll get into trouble.

    IMHO, sux is still a great drug - a small dose breaks laryngospasm QUICKLY as opposed to playing other games trying to break it. I had never seen (or heard of, for that matter) a case of negative pressure pulmonary edema my first 12 years of practice. I've seen several cases (not mine) in the ensuing 12 years, usually caused by trying other methods to break a laryngospasm instead of using a little sux if you can't break it with positive pressure.
  6. by   athomas91
    yoga- i am not sure if you were serious about the question - but what you were doing is of course what the books call the "notch" - i have heard from some who have used it that it works - i think more than anything it po's the patient off due to pain and wakes them up enough to cough that stuff off the cords... but - from what the texts say - it should be tried along w/ PPV prior to sux...
  7. by   yoga crna
    athomas,
    I do the technique when I need to, I just didn't know it had a name. I guess I better hit the books and try to catch up with the students on this board.
    Yoga
  8. by   athomas91
    LOL .... yep - they named it...i have only had one laryngospasm and it wasn't effective for her...oh well.
  9. by   TraumaNurse
    Yoga,

    As described in Morgan and Mikhail, the "laryngospasm notch" is located behind the lobule of the pinna of each ear. It is bounded anteriorly by the ascending ramus of the mandible adjacent to the condyle, posteriorly by the mastoid process of the temporal bone, and cephalad by the base of the skull.
    Pressure is applied firmly inwardly toward the base of the skull on each side ising either the index or middle fingers while at the same time lifting the mandible at a right angle to the plane of the body. It is supposed to convert laryngospasm to stridor in 1-2 breaths and then to clear unobstructed respirations in 1-2 more breaths.

    I'm not sure (nor is the author) if laryngospasm is relieved by the jaw thrust or by a sympathetic resonse to the painful pressure. The author claims that this technique can eliminate the need to use succs.

    We are not taught this in school (We are taught CPAP, deepening anesthetic, succinylcholine etc), so I was just wondering if it is commonly used or not?
  10. by   loisane
    I have used this maneuver when a simple chin lift is not enough to maintain the airway. Sometimes it works, preventing the need to go to something more "invasive". Never tried it in the setting of a spasm, but I'll keep that in mind now.

    I'm with Yoga, never knew it had a name. But it is well known among anesthesia providers, at least the ones I have interacted with, as a student and since.

    loisane crna
  11. by   athomas91
    Traumanurse - it is actually in our laryngospasm "pathway" that we had to learn......funny...
  12. by   Gotosleepy
    laryngospasm notch.... kinda bogus ... (Larson CP. Laryngospasm - the best treatment. Anesthesiology 1998;89:1293-1294.)

    basically what you are doing is providing a better airway for your positive pressure ventilation....

    by the way, here is a clinical question:
    pt goes into laryngospasm, and you lose your IV (very difficult stick to begin with)....and they have MH... how do you manage that? I'll make the scenario a bit easier (no hx of ischemic cardiac, no hx of Cerebro-vascular dz)... and you are in the MRI suite w/ no access to any needles/blades to get into the trachea...

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