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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
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