Laryngospasm question

zrmorgan · Jul 9, 2004

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.

yoga crna · Jul 9, 2004

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

jwk · Jul 9, 2004

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.

athomas91 · Jul 10, 2004

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...

yoga crna · Jul 10, 2004

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

athomas91 · Jul 10, 2004

LOL .... yep - they named it...i have only had one laryngospasm and it wasn't effective for her...oh well.

TraumaNurse · Jul 10, 2004

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?

loisane · Jul 11, 2004

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

athomas91 · Jul 11, 2004

Traumanurse - it is actually in our laryngospasm "pathway" that we had to learn......funny...

Gotosleepy · Jul 12, 2004

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...