WordNet

a closure of the larynx that blocks the passage of air to the lungs
laryngeal spasm caused by the sudden contraction of laryngeal muscles

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/20 07:19:23」(JST)

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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.^{[dead link]}
Information for patients with laryngospasm – voicedoctor.net
LaryngospasmInfo.com Symptoms, Treatment, Causes, and Resources for Laryngospasm.^{[dead link]}
Links, Information and Resources about Laryngospasm Laryngospasm Information Network.^{[dead link]}

UpToDate Contents

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1. 声帯ひだ奇異性運動 paradoxical vocal fold motion
2. 麻酔後ケア病棟における合併症発生の概要 overview of complications occurring in the post anesthesia care unit
3. 咽喉頭逆流 laryngopharyngeal reflux
4. Anesthesia for tonsillectomy with or without adenoidectomy in children
5. ケタミン中毒 ketamine poisoning

English Journal

A prospective study of ketamine versus haloperidol for severe prehospital agitation.

Cole JB1,2, Moore JC2, Nystrom PC2, Orozco BS1,2, Stellpflug SJ3, Kornas RL2, Fryza BJ2, Steinberg LW2, O'Brien-Lambert A2, Bache-Wiig P2, Engebretsen KM3, Ho JD2.
Clinical toxicology (Philadelphia, Pa.).Clin Toxicol (Phila).2016 Aug;54(7):556-62. doi: 10.1080/15563650.2016.1177652. Epub 2016 Apr 22.
CONTEXT: Ketamine is an emerging drug for the treatment of acute undifferentiated agitation in the prehospital environment, however no prospective comparative studies have evaluated its effectiveness or safety in this clinical setting.OBJECTIVE: We hypothesized 5 mg/kg of intramuscular ketamine wo
PMID 27102743

Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients.

Baykal Tutal Z1, Gulec H2, Derelı N2, Babayıgıt M2, Kurtay A2, Inceoz H2, Horasanlı E2.
Irish journal of medical science.Ir J Med Sci.2016 Aug;185(3):699-704. doi: 10.1007/s11845-015-1348-8. Epub 2015 Sep 2.
BACKGROUND AND AIMS: In this study, we compared duration for reaching desired Ramsay Sedation Score (RSS) and postoperative recovery according to Modified Aldrete Score (MAS) of propofol and propofol-ketamine combination in a group of colonoscopy patients. Rates of cardiovascular, respiratory, laryn
PMID 26329313

Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations.

Nacci A1, Matteucci J, Romeo SO, Santopadre S, Cavaliere MD, Barillari MR, Berrettini S, Fattori B.
Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP).Folia Phoniatr Logop.2016 Jul 26;68(1):37-45. [Epub ahead of print]
OBJECTIVE: To perform a retrospective evaluation of the incidence of complications and adverse events during fiberoptic endoscopic evaluation of swallowing (FEES) in 2,820 examinations.PATIENTS AND METHODS: Subjects included in- and outpatients at Pisa University Hospital referred for FEES by other
PMID 27454127