"Laryngospasms" redirects here. For the parody group, see The Laryngospasms.
Laryngospasm is an uncontrolled or involuntary muscular contraction (spasm) of the vocal folds.[1] It may be 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. It may be associated with stridor or retractions.
Laryngospasm is characterized by involuntary spasms of the laryngeal muscles. It is associated with difficulty or inability to breathe or speak, retractions, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.[2] It may be followed by paroxysmal coughing and in partial laryngospasms, a stridor may be heard.[3] It requires prompt identification to avoid possibly fatal complications. It may present with loss of end-tidal carbon dioxide (for mechanically ventilated patients), chest or neck retractions and paradoxical chest wall movements.[3]
The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder inspiration, while exhalation remains easier.[1]
It is likely that more than 10% of drownings involve laryngospasm, but the evidence suggests that it is not usually effective at preventing water from entering the trachea.[4]
Causes
Laryngospasm is a primitive protective airway reflex that functions to protect against aspiration. However, it may be detrimental if there is sustained closure of the glottis resulting in blockage of respiration that hinders the free flow of air. It may be 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. [1]
It is most often reported 1) post-operatively after endotracheal extubation or 2) after sudden reflux of gastric contents.[2][5][1] It is common in drowning. It is estimated that in 10% of cases of drowning as a response to inhalation of water, death occurs due to asphyxia due to laryngospasm without any water in the lungs.[6] It is also a symptom of hypoparathyroidism.[7] It can sometimes occur during sleep, waking up the affected person. These episodic interruptions of sleep have been attributed to acute irritation due to gastro-oesophageal reflux.[2][8]
In children, rapid detection and management are imperative to prevent deadly complications such as cardiac arrest, hypoxia and bradycardia.[9]
Patients with a history of significant aspiration, asthma, exposure to airway irritants (smoke, dust, fumes, use of Desflurane), upper respiratory infections, airway anomalies, light anesthesia and patients with acute mental status depression may be at increased risk.[2][5]
It is likely that more than 10% of drownings involve laryngospasm, but the evidence suggests that it is not usually effective at preventing water from entering the trachea.[4]
Prevention
When gastroesophageal reflux disease (GERD) is the trigger, treatment of GERD can help manage laryngospasm. Proton pump inhibitors such as Dexlansoprazole (Dexilant), Esomeprazole (Nexium), and Lansoprazole (Prevacid) reduce the production of stomach acids, making reflux fluids less irritant. Prokinetic agents reduce the amount of acid available by stimulating movement in the digestive tract.[2]
Patients who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux.[3]
For acute context, making an upright position of the upper part of the body has been shown to shorten the spasm episodes. Fixation of the arms on stabilization of the body and slowing of breathing is also recommended.[3]
Incidence
Incidence has been estimated at approximately 1% in both adult and pediatric populations. Its incidence is reported to be more than triple in the very young (birth to 3 months of age), increasing to 10% in those with reactive airways. Other sub-populations with high incidence of laryngospams include patients undergoing tonsillectomy and adenoidectomy (25%).[10]
Treatment
Minor laryngospasm will resolve spontaneously in the majority of cases.[1]
Laryngospasm is one of the most common intraoperative complications. It may be life-threatening as it involves reflex closure of the laryngeal muscles and thus results in inability to ventilate the patient.[11] Treatment requires clearing secretions from the oropharynx, applying continuous positive airway pressure with 100% oxygen, followed by deepening the plane of anaesthesia with propofol, and/or paralyzing with succinylcholine.[10]
^ abNorth R (December 2002). "The pathophysiology of drowning". South Pacific Underwater Medicine Society Journal. Retrieved 4 October 2020.
^ abRogus-Pulia N, Barczi S, Robbins J (2017). "Disorders of swallowing.". In Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, Ritchie C (eds.). Hazzard's Geriatric Medicine and Gerontology (7th ed.). McGraw Hill. ISBN978-0-07-183345-5.
^Barrett KE, Barman SM, Brooks HL, Yuan JJ, eds. (2019). "Regulation of respiration". Ganong's Review of Medical Physiology (26th ed.). McGraw Hill. ISBN978-1-260-12240-4.
^Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, et al. (October 2011). "Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research". Journal of Bone and Mineral Research. 26 (10): 2317–2337. doi:10.1002/jbmr.483. PMC3405491. PMID 21812031.
^Thurnheer R, Henz S, Knoblauch A (September 1997). "Sleep-related laryngospasm". The European Respiratory Journal. 10 (9): 2084–2086. doi:10.1183/09031936.97.10092084. PMID 9311507.
^Lobo PE, Hadaya I, Thoeny A (2020). "Anesthesia in head and neck surgery.". In Lalwani AK (ed.). Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery (4th ed.). McGraw Hill. ISBN978-0-07-184764-3.
^ abGavel G, Walker RW (April 2014). "Laryngospasm in anaesthesia". Continuing Education in Anaesthesia Critical Care & Pain. 14 (2): 47–51. doi:10.1093/bjaceaccp/mkt031.
^Smith EB, Hunsberger J (2021). "Intraoperative complications and crisis management.". In Ellinas H, Matthes K, Alrayashi W, Bilge A (eds.). Clinical Pediatric Anesthesiology. McGraw Hill. ISBN978-1-259-58574-6.
laryngospasm, redirects, here, parody, group, uncontrolled, involuntary, muscular, contraction, spasm, vocal, folds, triggered, when, vocal, cords, area, trachea, below, vocal, folds, detects, entry, water, mucus, blood, other, substance, associated, with, str. Laryngospasms redirects here For the parody group see The Laryngospasms Laryngospasm is an uncontrolled or involuntary muscular contraction spasm of the vocal folds 1 It may be 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 It may be associated with stridor or retractions LaryngospasmSpecialtyENT surgery Contents 1 Signs and symptoms 2 Causes 3 Prevention 4 Incidence 5 Treatment 6 See also 7 References 8 Further reading 9 External linksSigns and symptoms EditLaryngospasm is characterized by involuntary spasms of the laryngeal muscles It is associated with difficulty or inability to breathe or speak retractions a feeling of suffocation which may be followed by hypoxia induced loss of consciousness 2 It may be followed by paroxysmal coughing and in partial laryngospasms a stridor may be heard 3 It requires prompt identification to avoid possibly fatal complications It may present with loss of end tidal carbon dioxide for mechanically ventilated patients chest or neck retractions and paradoxical chest wall movements 3 The condition typically lasts less than 60 seconds but in cases partial blocking it may last 20 to 30 minutes and hinder inspiration while exhalation remains easier 1 It is likely that more than 10 of drownings involve laryngospasm but the evidence suggests that it is not usually effective at preventing water from entering the trachea 4 Causes EditLaryngospasm is a primitive protective airway reflex that functions to protect against aspiration However it may be detrimental if there is sustained closure of the glottis resulting in blockage of respiration that hinders the free flow of air It may be 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 1 It is most often reported 1 post operatively after endotracheal extubation or 2 after sudden reflux of gastric contents 2 5 1 It is common in drowning It is estimated that in 10 of cases of drowning as a response to inhalation of water death occurs due to asphyxia due to laryngospasm without any water in the lungs 6 It is also a symptom of hypoparathyroidism 7 It can sometimes occur during sleep waking up the affected person These episodic interruptions of sleep have been attributed to acute irritation due to gastro oesophageal reflux 2 8 In children rapid detection and management are imperative to prevent deadly complications such as cardiac arrest hypoxia and bradycardia 9 Patients with a history of significant aspiration asthma exposure to airway irritants smoke dust fumes use of Desflurane upper respiratory infections airway anomalies light anesthesia and patients with acute mental status depression may be at increased risk 2 5 It is likely that more than 10 of drownings involve laryngospasm but the evidence suggests that it is not usually effective at preventing water from entering the trachea 4 Prevention EditWhen gastroesophageal reflux disease GERD is the trigger treatment of GERD can help manage laryngospasm Proton pump inhibitors such as Dexlansoprazole Dexilant Esomeprazole Nexium and Lansoprazole Prevacid reduce the production of stomach acids making reflux fluids less irritant Prokinetic agents reduce the amount of acid available by stimulating movement in the digestive tract 2 Patients who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux 3 For acute context making an upright position of the upper part of the body has been shown to shorten the spasm episodes Fixation of the arms on stabilization of the body and slowing of breathing is also recommended 3 Incidence EditIncidence has been estimated at approximately 1 in both adult and pediatric populations Its incidence is reported to be more than triple in the very young birth to 3 months of age increasing to 10 in those with reactive airways Other sub populations with high incidence of laryngospams include patients undergoing tonsillectomy and adenoidectomy 25 10 Treatment EditMinor laryngospasm will resolve spontaneously in the majority of cases 1 Laryngospasm is one of the most common intraoperative complications It may be life threatening as it involves reflex closure of the laryngeal muscles and thus results in inability to ventilate the patient 11 Treatment requires clearing secretions from the oropharynx applying continuous positive airway pressure with 100 oxygen followed by deepening the plane of anaesthesia with propofol and or paralyzing with succinylcholine 10 See also EditLaryngotracheal stenosisReferences Edit a b c d e Gavel G Walker RW 26 August 2013 Laryngospasm in anaesthesia Continuing Education in Anaesthesia Critical Care amp Pain 14 2 47 51 doi 10 1093 bjaceaccp mkt031 a b c d e Watson S 11 November 2022 Felson S ed Laryngospasm Heartburn GERD Guide WebMD Retrieved 8 February 2017 a b c d Gdynia HJ Kassubek J Sperfeld AD 2006 Laryngospasm in neurological diseases Neurocritical Care 4 2 163 167 doi 10 1385 NCC 4 2 163 PMID 16627908 S2CID 37695632 a b North R December 2002 The pathophysiology of drowning South Pacific Underwater Medicine Society Journal Retrieved 4 October 2020 a b Rogus Pulia N Barczi S Robbins J 2017 Disorders of swallowing In Halter JB Ouslander JG Studenski S High KP Asthana S Supiano MA Ritchie C eds Hazzard s Geriatric Medicine and Gerontology 7th ed McGraw Hill ISBN 978 0 07 183345 5 Barrett KE Barman SM Brooks HL Yuan JJ eds 2019 Regulation of respiration Ganong s Review of Medical Physiology 26th ed McGraw Hill ISBN 978 1 260 12240 4 Bilezikian JP Khan A Potts JT Brandi ML Clarke BL Shoback D et al October 2011 Hypoparathyroidism in the adult epidemiology diagnosis pathophysiology target organ involvement treatment and challenges for future research Journal of Bone and Mineral Research 26 10 2317 2337 doi 10 1002 jbmr 483 PMC 3405491 PMID 21812031 Thurnheer R Henz S Knoblauch A September 1997 Sleep related laryngospasm The European Respiratory Journal 10 9 2084 2086 doi 10 1183 09031936 97 10092084 PMID 9311507 Lobo PE Hadaya I Thoeny A 2020 Anesthesia in head and neck surgery In Lalwani AK ed Current Diagnosis amp Treatment Otolaryngology Head and Neck Surgery 4th ed McGraw Hill ISBN 978 0 07 184764 3 a b Gavel G Walker RW April 2014 Laryngospasm in anaesthesia Continuing Education in Anaesthesia Critical Care amp Pain 14 2 47 51 doi 10 1093 bjaceaccp mkt031 Smith EB Hunsberger J 2021 Intraoperative complications and crisis management In Ellinas H Matthes K Alrayashi W Bilge A eds Clinical Pediatric Anesthesiology McGraw Hill ISBN 978 1 259 58574 6 Further reading EditLarson CP November 1998 Laryngospasm the best treatment Anesthesiology 89 5 1293 1294 doi 10 1097 00000542 199811000 00056 PMID 9822036 External links Edit Retrieved from https en wikipedia org w index php title Laryngospasm amp oldid 1136194374, wikipedia, wiki, book, books, library,
