Ketamine Induced Laryngospasm – A Link To Guidance From First10EM And Other Resources

This blog is simply my peripheral brain on the internet. [Before tablets and smart phones (not that long ago) doctors would carry a little notebook in their lab coat pocket of information they wanted to have immediately available-the peripheral brain.]

Resource (1) below on ketamine induced laryngospasm by Dr. Morganstern is very complete.

This post is basically a reminder to me to review his post if it’s been awhile since I’ve been involved in a ketamine procedural sedation.

I think any doctor or nurse who participates in procedural sedation can profit from reviewing Dr Morganstern’s post on laryngospasm.

And in his post Dr. Morganstern goes over how to use the Larson Maneuver to treat laryngospasm.

Resource (3) is a link to a YouTube video demonstrating the Larson Manuever.

Resource (4) Laryngospasm from Life In the Fast Lane reminds us:

Laryngospasm:

  • Laryngospasm may be preceded by a high-pitched inspiratory stridor — some describe a characteristic ‘crowing‘ noise — followed by complete airway obstruction.
  • It can occur without any warning signs.
  • It should be suspected whenever airway obstruction occurs, particularly in the absence of an obvious supraglottic cause.
  • Laryngospasm may not be obvious* — it may present as increased work of breathing (e.g. tracheal tug, indrawing), vomiting or desaturation [or a flat waveform on capnography].

*Think of laryngospasm when the capnography wave form goes flat or the oxygen saturation decreases (but decreased oxygen saturation will occur much later which is why you always want to be using wave form capnography for procedural sedation).

Complete airway obstruction is characterized by:

  • No chest wall movement with no breath sounds on auscultation
  • No stridor or airway sounds
  • Sudden loss of carbon dioxide waveform
  • Inability to manually ventilate with bag-mask ventilation

Resources:

(1) Managing laryngospasm in the emergency department by Dr Justin Morgenstern
Posted on March 3, 2016 from First10EM.

(2) LARYNGOSPASM AFTER KETAMINE, JUNE 1, 2012 from RESUS.ME – Resuscitation Medicine Education.

(3) The Larson Maneuver To Treat Laryngospasm (0:27) YouTube video from NEJM Video

(4) Laryngospasm from In The Fast Lane

(5) Pediatric laryngospasm [PubMed Abstract] [Full Text PDF]. Paediatr Anaesth. 2008 Apr;18(4):303-7. doi: 10.1111/j.1460-9592.2008.02446.x.

 

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