Laryngospasm Notch Maneuver

Aka: Laryngospasm Notch Maneuver, Laryngospasm on Induction

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II. Indications

  1. Laryngospasm (especially with Ketamine in children)

III. Mechanism

  1. Unclear (may be due to jaw-thrust motion or vagal nerve stimulation)

IV. Risk Factors

  1. Laryngospasm with Ketamine is more common in children, but still rare

V. Technique

  1. Bilateral Landmarks
    1. Identify a notch posterior to Ear Pinna and anterior to mastoid process
    2. Pressure point will be at the very apex of the notch, as high as possible along the posterior edge of Mandible ramus
  2. Maneuver
    1. Press on both sides, at the apex of each notch
    2. Push inward and anterior at each of the 2 notches
  3. Effect
    1. Laryngospasm typically improves within 1-2 breaths

VI. Management: Alternative Measures for Laryngospasm with Consious Sedation or Induction

  1. See Ketamine
  2. Jaw Thrust Maneuver (create an "underbite")
  3. Two-handed bag-valve mask (BVM) with a second provider applying the mask (with C-E positioning)
  4. Paralysis (Rocuronium or Succinylcholine) and intubation

VII. Resources

  1. ALIEM: Laryngospasm Notch Maneuver (Lin, 2010)
    1. https://www.aliem.com/2010/trick-of-trade-laryngospasm-notch/

VIII. References

  1. Larson (1998) Anesthesiology 89:1293-4 +PMID:9822036 [PubMed]

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