It is essential that one apply the pressure at the proper location to correct laryngospasm. One MUST FEEL THE BASE OF THE SKULL SUPERIORLY, THE MASTOID PROCESS POSTERIORLY, AND THE CORONOID PROCESS OF THE MANDIBLE ANTERIORLY. any lower than that and it doesn’t work. Usually the pressure point is covered by the ear lobes. Pressure is directed inward and must be done FIRMLY. One cannot be a wimp about it!! Applying the same pressure at the angle of the jaw, ie jaw thrust, does not resolve laryngospasm.I do the maneuver immediately after extubating the trachea, since I cannot tell, nor can anyone else whether the patient is in laryngospasm just by looking at them, unless they are vigorously breathing and mist (fog) is entering the mask. Patients can look like they are breathing, but no gas may be moving past the cords. It’s such an easy thing to do and corrects airway obstruction from both laryngospasm and the tongue falling back against the posterior pharyngeal wall. Why not do it after every extubation?? The patients won’t remember it, and there are no serious complications from doing so.Why does it work?? That question I cannot answer with confidence. However, it is not due to pain alone, since pain instituted in other areas, such as abdominal or rectal pain will induce laryngospasm. I believe that the maneuver activates the 9th and 10th cranial nerves, but I cannot prove that theory.As stated above, there is no complication from doing this. As I state, I have done it many thousands of times and it has never failed. I appreciate that nothing is perfect, but this comes as close to perfect as one can get provided it is done correctly!! Skeptics should do it 200 times and they will become confirmed believers. And patients will be spared episodes of hypoxemia, or worse, negative pressure pulmonary edema. Phil Larson
| | |