Laryngospasm

Background
  • 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


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

Disposition
  • Observation for 2-3 hours after resolution for development of post-obstructive pulmonary edema, bradycardia, or aspiration

See Also

Airway Pages

References
  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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