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Laryngospasm

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Laryngospasm

Laryngospasm
Classification and external resources
ICD-10 J38.5
ICD-9-CM 478.75
MeSH D007826

In medicine, laryngospasm is an uncontrolled/involuntary muscular contraction (spasm) of the vocal folds. The condition typically lasts less than 60 seconds, 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 and/or retractions. Some people suffer from 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.

Etiology

In some individuals this can occur spontaneously or as a result of reflux or impaired swallowing. GERD is a common cause of spontaneous laryngospasm. Treating GERD can lessen the frequency of spasms. The onset of spasms may be caused by a viral infection.

It is also a complication associated with anesthesia. The spasm can happen often without any provocation, but tends to occur after tracheal extubation. In children, the condition can be particularly deadly, leading to cardiac arrest within 30–45 seconds, and is a possible cause of death associated with the induction of general anesthesia in the pediatric population. It can sometimes occur during sleep, waking up the patient. This usually occurs when the patient has gastric acidity and develops re-flux during sleep, where the gastric acid causes irritation which will cause the spasm attack.

Treatment

Minor laryngospasm will generally resolve spontaneously.

Laryngospasm in the operating room is treated by hyperextending the patient's neck and administering assisted ventilation with 100% oxygen. In more severe cases it may require the administration of an intravenous muscle relaxant, such as Succinylcholine, and reintubation.

In ear, nose and throat practices, it is treated by examining the patient in the office and reassuring the patient that laryngospasm resolves. Sometimes reflux medication is used to reduce the acidity in the stomach.

Spontaneous laryngospasm can be treated by staying calm and breathing slowly, instead of gasping for air. Drinking water to wash away any irritants that may be the cause of the spasm can also help greatly.

Patients who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux, and constantly drinking water or tea keep the area clear of irritants.

Additionally, laryngospasms can result from hypocalcemia, causing muscle spasms and/or tetany. Na+ channels remain open even if there is very little increase in the membrane potential. This affects the small muscles of the vocal folds.

Prevention

When laryngospasm is coincident with a cold or flu, it may be helpful for some sufferers to take acid reflux medication to limit the irritants in the area. If a cough is present, then treat a wet cough; but limit coughing whenever possible, as it is only likely to trigger a spasm. Drink water or tea to keep the area from drying up. Saline drops also help to keep the area moist. Sudafed may also help to clear any mucus that may cause coughing and thereby triggering more spasms.

Because spasms tend to last a short time but are very scary and feel like they last a long time, holding your breath during the spasm is a strategy for dealing with the spasm until it is over. Holding your breath and putting saline drops while holding your head back can give the sufferer something to do to both help the situation and distract the sufferer.

External links

  • -1999634387 at GPnotebook
  • emerg/802 at eMedicine "Ketamine: Emergency Applications" – discusses laryngospasm.
  • Information for patients with laryngospasm – voicedoctor.net
  • LaryngospasmInfo.com Symptoms, Treatment, Causes, and Resources for Laryngospasm.
  • Links, Information and Resources about Laryngospasm Laryngospasm Information Network.
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