Jump to content

Laryngospasm: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
→‎Diagnosis: Remove as laryngospasm refers to a symptom
→‎Signs and symptoms: Updated with citations
Line 31: Line 31:
==Signs and symptoms==
==Signs and symptoms==


The main symptom is choking and difficulty or inability to breathe or speak, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.<ref name="WebMD" /> As the airway reopens, breathing may cause a high-pitched sound called [[stridor]]. GERD associated episodes seldom lasts over a couple of minutes before breathing is back to normal.<ref name="WebMD" />
Laryngospasm is characterized by involuntary spasms of the laryngeal muscles. It is associated with difficulty or inability to breathe or speak, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.<ref name="WebMD" /> It may be followed by paroxysmal coughing and in partial laryngospasms, a stridor may be heard.<ref>Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Paediatr Anaesth. 2008 Apr;18(4):303–307.</ref>. <ref name=Gdynia2006>Gdynia HJ, Kassubek J, Sperfeld AD. Laryngospasm in neurological diseases. Neurocrit Care. 2006;4(2):163-7. doi: 10.1385/NCC:4:2:163. PMID: 16627908.</ref> 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. <ref name=Gdynia2006/>


==Causes==
==Causes==

Revision as of 15:38, 24 December 2022

"Laryngospasms" redirects here. For the parody group, see The Laryngospasms.
Laryngospasm
SpecialtyENT surgery

Laryngospasm is an uncontrolled or involuntary muscular contraction (spasm) of the vocal folds.[1] The condition typically lasts less than 60 seconds, but in some cases can last 20–30 minutes and causes a partial blocking of breathing in, while breathing out remains easier. 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 is characterized by stridor or retractions.[1][clarification needed] Some people have frequent laryngospasms, whether awake or asleep. In an ear, nose, and throat practice, it is typically seen in people who have silent reflux disease. It is also a well known, infrequent, but serious perioperative complication.[2]

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.[3]

Signs and symptoms

Laryngospasm is characterized by involuntary spasms of the laryngeal muscles. It is associated with difficulty or inability to breathe or speak, 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.[4]. [5] 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. [5]

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.[1] It is most often reported 1) post-operatively after endotracheal extubation or 2) after sudden reflux of gastric contents.[2] [6] [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.[7] It is also a symptom of hypoparathyroidism.[8] 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][9]

In children, rapid detection and management are imperative to prevent deadly complications such as cardiac arrest, hypoxia and bradycardia.[10]

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] [6]

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.[11]

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.[11]

Incidence

Incidence has been estimated at approximately 1% in both adult and pediatric populations. It is reported to be more than triples 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%).[12]

Treatment

Minor laryngospasm will generally 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.[13] 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. [12]

See also

References

  1. ^ a b c d e Gavel, Gil; Walker, Robert W. M. (26 August 2013). "Laryngospasm in anaesthesia". Continuing Education in Anaesthesia, Critical Care & Pain. 14 (2): 47–51. doi:10.1093/bjaceaccp/mkt031.
  2. ^ a b c d e f Staff. "Laryngospasm". Heartburn/GERD Guide. WebMD. Retrieved 8 February 2017.
  3. ^ North, Robert (December 2002). "The pathophysiology of drowning". South Pacific Underwater Medicine Society Journal. Retrieved 4 October 2020.
  4. ^ Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Paediatr Anaesth. 2008 Apr;18(4):303–307.
  5. ^ a b Gdynia HJ, Kassubek J, Sperfeld AD. Laryngospasm in neurological diseases. Neurocrit Care. 2006;4(2):163-7. doi: 10.1385/NCC:4:2:163. PMID: 16627908.
  6. ^ a b Rogus-Pulia N, & Barczi S, & Robbins J (2017). Disorders of swallowing. Halter J.B., & Ouslander J.G., & Studenski S, & High K.P., & Asthana S, & Supiano M.A., & Ritchie C(Eds.), Hazzard's Geriatric Medicine and Gerontology, 7e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=1923§ionid=144520375
  7. ^ Regulation of respiration. Barrett K.E., & Barman S.M., & Brooks H.L., & Yuan J.J.(Eds.), (2019). Ganong's Review of Medical Physiology, 26e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2525§ionid=204297794
  8. ^ Bilezikian, J. P.; Khan, A.; Potts, J. T. Jr.; Brandi, M. L.; Clarke, B. L.; Shoback, D.; Jüppner, H.; d'Amour, P.; Fox, J.; Rejnmark, L.; Mosekilde, L.; Rubin, M. R.; Dempster, D.; Gafni, R.; Collins, M. T.; Sliney, J.; Sanders, J. (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.
  9. ^ Thurnheer R, Henz S, Knoblauch A. Sleep-related laryngospasm. Eur Respir J. 1997 Sep;10(9):2084-6. doi: 10.1183/09031936.97.10092084. PMID: 9311507.
  10. ^ Peter Lobo E, & Hadaya I, & Thoeny A (2020). Anesthesia in head and neck surgery. Lalwani A.K.(Ed.), Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery, 4e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2744§ionid=229670529
  11. ^ a b Gdynia, Hans-Jürgen; Kassubek, Jan; Sperfeld, Anne-Dorte (2006). "Laryngospasm in Neurological Diseases". Neurocritical Care. 4 (2): 163–167. doi:10.1385/ncc:4:2:163. ISSN 1541-6933. PMID 16627908. S2CID 37695632.
  12. ^ a b Gil Gavel, FRCA, Robert WM Walker, FRCA, Laryngospasm in anaesthesia, Continuing Education in Anaesthesia Critical Care & Pain, Volume 14, Issue 2, April 2014, Pages 47–51, https://doi.org/10.1093/bjaceaccp/mkt031
  13. ^ Smith E.B., & Hunsberger J (2021). Intraoperative complications and crisis management. Ellinas H, & Matthes K, & Alrayashi W, & Bilge A(Eds.), Clinical Pediatric Anesthesiology. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=2985§ionid=250592587
Retrieved from "https://en.wikipedia.org/w/index.php?title=Laryngospasm&oldid=1129296422"