Tips | In addition to pressurizing and oxygenating, this trick will also get immediate results when laryngospasm is used

Laryngeal spasm refers to the reflex spasmodic contraction of the laryngeal muscles, which causes the vocal cords to be adducted, and the glottis is partially or completely closed, which leads to varying degrees of breathing difficulties and even complete airway obstruction.

Laryngeal spasm is the body's protective reflex to prevent foreign bodies from invading.
It is a functional respiratory obstruction.
Although it is not very common, it is fierce.

It often occurs in children less than 5 years old.
Risk factors include upper respiratory tract infection, obesity, OSAS, asthma, passive smoking, etc.

It is often caused by irritation of the throat, such as sputum suction under light anesthesia, throat surgery, bloody secretions, etc.

Laryngeal spasm is a common but life-threatening complication in pediatric anesthesia.
It needs urgent treatment.
If it is not handled in time, it can lead to serious complications.

Generally speaking, there are not too many emergencies that an anesthesiologist can remember for a lifetime, but laryngospasm, especially severe and complete laryngospasm, is absolutely unforgettable for a lifetime, once is enough.

An anesthesiologist who has experienced a laryngeal spasm will really feel the danger of anesthesia, because the whole process is extremely tense, the patient’s hypoxia speed is beyond recognition, and the relief process is also very rapid, the whole process may be within a few minutes ended.

Anesthesiologists who have been in the clinic for more than a year are not unfamiliar with laryngospasm, and they will deal with it very quickly.

For such dangerous complications of anesthesia, timely rescue measures are particularly critical, and effective methods may be immediate; the treatment measures for laryngospasm are mainly to control the airway and medication to relieve the spasm; start the pure oxygen pressure mask immediately after stopping the adverse stimulation Continuous positive pressure ventilation, the purpose is to try to open the glottis through gas pressure, when the effect is not good, you need to use propofol or succinylcholine at the same time to treat spasm, try to directly intubate or wait for the patient to relax after extreme hypoxia.
Dangerous method.

Recently, I learned an effective method for relieving laryngospasm-chest compression, and found that the effect is excellent in practice.

The method of chest compression is to press on the sternum at the base of the palm of the hand when the hands are pressurized and ventilated with a 100% pure oxygen mask.
The compression depth is about half of the standard CPR chest compression depth, and the compression frequency is 20-25 times/min.

The principle is not complicated.
Pressurized mask ventilation is to force air to rush through the vocal cords into the lungs to complete the exchange, while chest compressions are just the opposite.
Compressing the thorax forces the air in the lungs to rush out of the vocal cords to complete the exchange between inside and outside the lungs.
Both can effectively improve the state of hypoxia.

Chest compressions are used to relieve laryngospasm.
It was reported as early as 1983 [1], and related studies were also analyzed in the follow-up.

A four-year large sample study of 1226 children aged 3-12 years compared the success rate of relieving laryngospasm between the chest compression group and the oxygen mask compression group [2].
632 patients in the first two years were included In the pure oxygen mask compression group (control group), 52 cases of laryngospasm occurred, and the remission success rate was 38.
4% (20 /52); 594 patients in the following two years were included in pure oxygen mask inhalation + gentle chest compressions Group (experimental group), 46 cases of laryngospasm had a remission success rate of 73.
9% (34/46), and none of the children in the chest compression group had gastric dilatation, while the incidence of gastric dilatation in the control group was as high as 86 .
5% (45 /52).

This method not only improves the success rate of laryngospasm relief, but also greatly reduces the risk that continuous positive pressure ventilation may cause reflux of gastric contents.

Another study also obtained similar results, chest compressions combined with mask pure oxygen inhalation can relieve most children's laryngospasm during removal and extubation of tonsils and adenoids, and the rate of gastric dilatation at the same time is significantly reduced [3].

In short, when laryngospasm occurs, immediately pressurized ventilation with pure oxygen, and at the same time with appropriate chest compressions, if there is still no significant improvement, you should immediately inject propofol (1mg/kg) or succinylcholine (1mg/kg, or Rocuronium 1mg/kg) was completed after intubation to control the airway.

Bits of knowledge will be shared with you, and I hope to gain something for you! References 1.
Pearce H.
Laryngeal spasm [J].
Anaesth Intensive Care, 1983, 11(4):389-390.
2.
Al-Metwalli RR, Mowafi HA, Ismail SA.
Gentle chest compression relieves extubation laryngospasm in children［J］．J Anesth, 2010, 24(6): 854-857.
3.
Wu Yuchao, Sun Zhipeng, Luo Ting, et al.
Application of chest compression in the treatment of laryngospasm after extubation of tonsil or adenoid surgery in children[J].
Shandong Medicine, 2013, 53(8): 49-50.