Laryngospasm

Background

Larynx as visualized from the hypopharynx.

The cartilages and ligaments of the larynx seen posteriorly.

External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.

Sagittal section through the head and neck showing the subdivisions of the pharynx.

An uncontrolled or involuntary muscular contraction of the vocal folds.
Reflex is normally triggered when the vocal cords or the area of the trachea below the vocal folds detects the entry of water, mucus, blood, or other substance.
Associated with ketamine (0.3%)
- Usually associated with large doses or rapid IV push

Causes

Clinical Features

Apnea may be the only sign in complete closure
Partial closure can manifest as stridor, guttural noises, and paradoxical chest movement

Differential Diagnosis

Oversedation
Failure of respiratory drive

Evaluation

Workup

Typically not indicated

Diagnosis

Typically a clinical diagnosis

Management

Apply pressure inwardly and anteriorly to the point labeled "Pressure Point" (Larson's Point) while applying a jaw thrust to relieve laryngospasm ^[1]

Jaw thrust
Place pressure on Larson's notch
If jaw thrust and pressure are not sufficient, bag valve mask with PEEP
If above do not resolve laryngospasm, sedate more deeply (propofol is the traditional choice, 0.5mg/kg)
If deeper sedation does not resolve laryngospasm, paralyze and intubate
In pediatric patients, consider gentle chest compressions

Disposition

Observation for 2-3 hours after resolution for development of post-obstructive pulmonary edema, bradycardia (consider atropine), or aspiration

External Links

References

↑ Larson CP Jr. Laryngospasm--the best treatment. Anesthesiology. 1998 Nov;89(5):1293-4. doi: 10.1097/00000542-199811000-00056. PMID: 9822036.

Authors:

[1] Larson CP Jr. Laryngospasm--the best treatment. Anesthesiology. 1998 Nov;89(5):1293-4. doi: 10.1097/00000542-199811000-00056. PMID: 9822036.

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