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{{short description|Involuntary contraction of the vocal folds restricting inhalation }}
{{short description|Involuntary contraction of the vocal folds restricting inhalation }}
{{Redirect|Laryngospasms|the parody group|The Laryngospasms}}
{{Redirect|Laryngospasms|the parody group|The Laryngospasms}}
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'''Laryngospasm''' is an uncontrolled or involuntary muscular contraction ([[muscle spasm|spasm]]) of the [[vocal folds]].<ref name="Gavel and Walker 2013" /> The condition typically lasts less than 60 seconds, but in some cases can last 20–30 minutes 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.<ref name="Gavel and Walker 2013" />{{clarify|reason= what are retractions?|date=February 2017}} 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 [[Laryngopharyngeal reflux|silent reflux disease]]. It is also a well known, infrequent, but serious [[perioperative]] complication.<ref name="WebMD" />
'''Laryngospasm''' is an uncontrolled or involuntary muscular contraction ([[muscle spasm|spasm]]) of the [[vocal folds]].<ref name="Gavel_2013" /> 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 may be associated with [[stridor]] or [[Labored breathing|retractions]].

⚫
It is likely that more than 10% of [[drowning]]s involve laryngospasm, but the evidence suggests that it is not usually effective at preventing water from entering the trachea.<ref name="North 2002"/>


==Signs and symptoms==
==Signs and symptoms==


The main symptom is choking and difficulty or inability to breathe or speak, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.<ref name="WebMD" /> As the airway reopens, breathing may cause a high-pitched sound called [[stridor]]. The episode seldom lasts over a couple of minutes before breathing is back to normal.<ref name="WebMD" />
Laryngospasm is characterized by involuntary spasms of the laryngeal muscles. It is associated with difficulty or inability to breathe or speak, [[Labored breathing|retractions]], a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.<ref name="WebMD" /> It may be followed by paroxysmal coughing and in partial laryngospasms, a stridor may be heard.<ref name = "Gdynia_2006">{{cite journal | vauthors = Gdynia HJ, Kassubek J, Sperfeld AD | title = Laryngospasm in neurological diseases | journal = Neurocritical Care | year = 2006 | volume = 4 | issue = 2 | pages = 163–167 | pmid = 16627908 | doi = 10.1385/NCC:4:2:163 | s2cid = 37695632 }}</ref> It requires prompt identification to avoid possibly fatal complications. It may present with loss of end-tidal carbon dioxide (for mechanically ventilated patients), chest or neck retractions and paradoxical chest wall movements.<ref name = "Gdynia_2006" />

The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder [[Inhalation|inspiration]], while [[exhalation]] remains easier.<ref name="Gavel_2013" />


==Causes==
==Causes==
Various stimuli including asthma, allergies, exercise, stress, and irritants such as smoke, dust, fumes, liquids, and food can trigger laryngospasm.<ref name="WebMD" /> It is common in drowning, both as a direct response to inhalation of water, and as a complication during rescue and resuscitation due to aspiration of vomit.{{cn|date=November 2020}}


Laryngospasm is a primitive protective airway reflex that functions to protect against [[Pulmonary aspiration|aspiration]]. However, it may be detrimental if there is sustained closure of the [[glottis]] resulting in blockage of respiration that hinders the free flow of air. 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. <ref name="Gavel_2013" />
In some individuals laryngospasm can occur spontaneously or as a result of reflux or impaired swallowing. [[Gastroesophageal reflux disease]] (GERD) is a common cause of spontaneous laryngospasm.<ref name="WebMD" /> Treating GERD can lessen the frequency of spasms. The onset of spasms may be caused by a viral infection.{{cn|date=February 2017}}


It is most often reported 1) post-operatively after endotracheal extubation or 2) after sudden reflux of gastric contents.<ref name="WebMD" /> <ref name=Rogus2017>{{cite book | vauthors = Rogus-Pulia N, Barczi S, Robbins J | date = 2017 | chapter = Disorders of swallowing.| veditors = Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, Ritchie C | title = Hazzard's Geriatric Medicine and Gerontology | edition = 7th | publisher = McGraw Hill | chapter-url = https://accessmedicine.mhmedical.com/content.aspx?bookid=1923&sectionid=144520375 | isbn = 978-0-07-183345-5 }}</ref><ref name="Gavel_2013" /> It is common in drowning. It is estimated that in 10% of cases of drowning as a response to inhalation of water, death occurs due to asphyxia due to laryngospasm without any water in the lungs.<ref>{{cite book | chapter = Regulation of respiration | veditors = Barrett KE, Barman SM, Brooks HL, Yuan JJ | date = 2019 | title = Ganong's Review of Medical Physiology | edition = 26th | publisher = McGraw Hill | chapter-url = https://accessmedicine.mhmedical.com/content.aspx?bookid=2525&sectionid=204297794 | isbn = 978-1-260-12240-4 }}</ref> It is also a symptom of [[hypoparathyroidism]].<ref>{{cite journal | vauthors = Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, Jüppner H, D'Amour P, Fox J, Rejnmark L, Mosekilde L, Rubin MR, Dempster D, Gafni R, Collins MT, Sliney J, Sanders J | display-authors = 6 | title = Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research | journal = Journal of Bone and Mineral Research | volume = 26 | issue = 10 | pages = 2317–2337 | date = October 2011 | pmid = 21812031 | pmc = 3405491 | doi = 10.1002/jbmr.483 }}</ref> It can sometimes occur during sleep, waking up the affected person. These episodic interruptions of sleep have been attributed to acute irritation due to gastro-oesophageal reflux.<ref name="WebMD" /><ref>{{cite journal | vauthors = Thurnheer R, Henz S, Knoblauch A | title = Sleep-related laryngospasm | journal = The European Respiratory Journal | volume = 10 | issue = 9 | pages = 2084–2086 | date = September 1997 | pmid = 9311507 | doi = 10.1183/09031936.97.10092084 | doi-access = free }}</ref> Laryngospasm is also an unlikely but possible side effect of [[ketamine]] administration.<ref>{{Cite journal |last=Melendez |first=Elliot |last2=Bachur |first2=Richard |date=May 2009 |title=Serious Adverse Events During Procedural Sedation With Ketamine: |url=http://journals.lww.com/00006565-200905000-00008 |journal=Pediatric Emergency Care |language=en |volume=25 |issue=5 |pages=325–328 |doi=10.1097/PEC.0b013e3181a341e0 |issn=0749-5161}}</ref> Laryngospasm may happen in people with neurological disease.<ref>{{Cite journal |last=Gdynia |first=Hans-Jürgen |last2=Kassubek |first2=Jan |last3=Sperfeld |first3=Anne-Dorte |date=2006 |title=Laryngospasm in Neurological Diseases |url=http://link.springer.com/10.1385/NCC:4:2:163 |journal=Neurocritical Care |language=en |volume=4 |issue=2 |pages=163–167 |doi=10.1385/NCC:4:2:163 |issn=1541-6933}}</ref>
It is also a complication associated with [[anesthesia]]. The spasm can happen often without any provocation, but tends to occur after [[Vertebrate trachea|tracheal]] [[extubation]].<ref name="Gavel and Walker 2013" /> 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. These situations are not to be confused with the benign laryngospam events seen in infants after feeding or due to reflux.<ref name="WebMD" />


In children, rapid detection and management are imperative to prevent deadly complications such as cardiac arrest, hypoxia and bradycardia.<ref name=Lobo2020>{{cite book | vauthors = Lobo PE, Hadaya I, Thoeny A | date = 2020 | chapter = Anesthesia in head and neck surgery. | veditors = Lalwani AK | title = Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery | edition = 4th | publisher = McGraw Hill | chapter-url = https://accessmedicine.mhmedical.com/content.aspx?bookid=2744&sectionid=229670529 | isbn = 978-0-07-184764-3 }}</ref>
It can sometimes occur during sleep, waking up the sufferer. This usually occurs when the person has gastric acidity and develops re-flux during sleep, where the gastric acid causes irritation which will cause the spasm attack.<ref name="WebMD" />


Patients with a history of significant aspiration, asthma, exposure to airway irritants (smoke, dust, mold, fumes, use of [[Desflurane]]), upper respiratory infections, airway anomalies, light anesthesia and patients with acute mental status depression may be at increased risk.<ref name="WebMD" /><ref name=Rogus2017/>
It is also a symptom of [[hypoparathyroidism]].<ref>{{Cite journal|pmid = 21812031|year = 2011|last1 = Bilezikian|first1 = J. P.|last2 = Khan|first2 = A.|last3 = Potts Jr|first3 = J. T.|last4 = Brandi|first4 = M. L.|last5 = Clarke|first5 = B. L.|last6 = Shoback|first6 = D.|last7 = Jüppner|first7 = H.|last8 = d'Amour|first8 = P.|last9 = Fox|first9 = J.|last10 = Rejnmark|first10 = L.|last11 = Mosekilde|first11 = L.|last12 = Rubin|first12 = M. R.|last13 = Dempster|first13 = D.|last14 = Gafni|first14 = R.|last15 = Collins|first15 = M. T.|last16 = Sliney|first16 = J.|last17 = Sanders|first17 = J.|title = Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research|journal = Journal of Bone and Mineral Research |volume = 26|issue = 10|pages = 2317–2337|doi = 10.1002/jbmr.483|pmc = 3405491}}</ref>

It can also be caused by some medications such as [[lurasidone]].<ref name="Caffrey Sowden 2021 pp. 73–82">{{cite journal | last1=Caffrey | first1=Deirdre | last2=Sowden | first2=Gillian L | title=A missed case of lurasidone induced laryngospasm: A case study and overview of extrapyramidal symptom identification and treatment | journal=International Journal of Psychiatry in Medicine | volume=56 | issue=2 | date=2020-07-13 | issn=0091-2174 | pmid=32660283 | doi=10.1177/0091217420943786 | pages=73–82}}</ref>


==Prevention==
==Prevention==
⚫
When gastroesophageal reflux disease (GERD) is the trigger, treatment of GERD can help manage laryngospasm. Proton pump inhibitors such as [[Dexlansoprazole]] (Dexilant), [[Esomeprazole]] (Nexium), and [[Lansoprazole]] (Prevacid) reduce the production of stomach acids, making reflux fluids less irritant. [[Prokinetic agent]]s reduce the amount of acid available by stimulating movement in the digestive tract.<ref name="WebMD" />
Due to the shape of the stomach and position of the esophagus, sleep-related laryngospasms may be prevented by sleeping on the left side, which can help in keeping stomach acid from entering the esophagus and reaching the vocal cords.


⚫
Patients who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux.<ref name="Gdynia_2006"/>
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.{{cn|date=February 2017}} If a cough is present, then treat a wet cough; but limit coughing whenever possible, as it is only likely to trigger a spasm.{{cn|date=February 2017}} Drink water or tea to keep the area from drying up.{{cn|date=February 2017}} Saline drops also help to keep the area moist.{{cn|date=February 2017}} Pseudoephederine may also help to clear any mucus that may cause coughing and thereby triggering more spasms.{{cn|date=February 2017}}


⚫
For acute context, making an upright position of the upper part of the body has been shown to shorten the spasm episodes. Fixation of the arms on stabilization of the body and slowing of breathing is also recommended.<ref name="Gdynia_2006" />
⚫
==Treatment==
Minor laryngospasm will generally resolve spontaneously in the majority of cases.<ref name="Gavel and Walker 2013" />


==Incidence==
Laryngospasm in the operating room is treated by [[hyperextension|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 [[intubation|reintubation]].{{cn|date=February 2017}}
Incidence has been estimated at approximately 1% in both adult and pediatric populations. Its incidence is reported to be more than triple in the very young (birth to 3 months of age), increasing to 10% in those with [[reactive airway disease|reactive airways]]. Other sub-populations with high incidence of laryngospams include patients undergoing tonsillectomy and adenoidectomy (25%).<ref name= "Gavel_2014" />


⚫
It is likely that more than 10% of [[drowning|drownings]] involve laryngospasm, but the evidence suggests that it is not usually effective at preventing water from entering the trachea.<ref name="North 2002"/>
⚫
When gastroesophageal reflux disease (GERD) is the trigger, treatment of GERD can help manage laryngospasm. Proton pump inhibitors such as [[Dexlansoprazole]] (Dexilant), [[Esomeprazole]] (Nexium), and [[Lansoprazole]] (Prevacid) reduce the production of stomach acids, making reflux fluids less irritant. [[Prokinetic agent]]s reduce the amount of acid available by stimulating movement in the digestive tract.<ref name="WebMD" />


⚫
==Treatment==
⚫
Patients who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux.<ref name="Gdynia Kassubek Sperfeld 2006 pp. 163–167"/>
Most minor laryngospasm get better on its own for most people.<ref name="Gavel_2013" />


Laryngospasm is one of the most common intraoperative complications. It may be life-threatening as it involves reflex closure of the laryngeal muscles and thus results in inability to ventilate the patient.<ref name = "Smith_2021">{{cite book | vauthors = Smith EB, Hunsberger J | date = 2021 | chapter = Intraoperative complications and crisis management.| veditors = Ellinas H, Matthes K, Alrayashi W, Bilge A | title = Clinical Pediatric Anesthesiology | publisher = McGraw Hill | chapter-url = https://accessanesthesiology.mhmedical.com/content.aspx?bookid=2985&sectionid=250592587 | isbn = 978-1-259-58574-6 }}</ref> Treatment requires clearing secretions from the [[oropharynx]], applying [[continuous positive airway pressure]] with 100% [[oxygen]], followed by deepening the plane of anaesthesia with [[propofol]], and/or paralyzing with [[succinylcholine]].<ref name= "Gavel_2014">{{cite journal | vauthors = Gavel G, Walker RW | title = Laryngospasm in anaesthesia | journal = Continuing Education in Anaesthesia Critical Care & Pain | volume = 14 | issue = 2 | date = April 2014 | pages = 47–51 | doi = 10.1093/bjaceaccp/mkt031 | doi-access = free }}</ref>
⚫
For acute context, making an upright position of the upper part of the body has been shown to shorten the spasm episodes. Fixation of the arms on stabilization of the body and slowing of breathing is also recommended.<ref name="Gdynia Kassubek Sperfeld 2006 pp. 163–167">{{cite journal | last1=Gdynia | first1=Hans-Jürgen | last2=Kassubek | first2=Jan | last3=Sperfeld | first3=Anne-Dorte | title=Laryngospasm in Neurological Diseases | journal=Neurocritical Care | volume=4 | issue=2 | year=2006 | issn=1541-6933 | pmid=16627908 | doi=10.1385/ncc:4:2:163 | pages=163–167}}</ref>


==See also==
== See also ==
* [[Laryngotracheal stenosis]]
* [[Laryngotracheal stenosis]]


==References==
== References ==
{{Reflist|30em|refs=
{{Reflist|30em|refs=


<ref name="Gavel and Walker 2013">{{cite journal|last1=Gavel|first1=Gil|first2=Robert W. M. |last2=Walker |date=26 August 2013 |title=Laryngospasm in anaesthesia |journal=Continuing Education in Anaesthesia, Critical Care & Pain |volume=14 |issue=2|pages=47–51 |doi=10.1093/bjaceaccp/mkt031}}</ref>
<ref name="Gavel_2013">{{cite journal| vauthors = Gavel G, Walker RW |date=26 August 2013 |title=Laryngospasm in anaesthesia |journal=Continuing Education in Anaesthesia, Critical Care & Pain |volume=14 |issue=2|pages=47–51 |doi=10.1093/bjaceaccp/mkt031|doi-access=free }}</ref>


<ref name="North 2002">{{cite journal|last=North|first=Robert|date=December 2002|title=The pathophysiology of drowning|journal=South Pacific Underwater Medicine Society Journal|url=https://www.researchgate.net/publication/228699347|access-date=4 October 2020}}</ref>
<ref name="North 2002">{{cite journal| vauthors = North R |date=December 2002|title=The pathophysiology of drowning|journal=South Pacific Underwater Medicine Society Journal|url=https://www.researchgate.net/publication/228699347|access-date=4 October 2020}}</ref>


<ref name=WebMD>{{cite web|url=http://www.webmd.com/heartburn-gerd/guide/laryngospasm-causes-symptoms-and-treatments#1|title=Laryngospasm|last=Staff|work=Heartburn/GERD Guide|publisher=WebMD|access-date=8 February 2017}}</ref>
<ref name=WebMD>{{cite web | vauthors = Watson S | veditors = Felson S | date = 11 November 2022 |url=http://www.webmd.com/heartburn-gerd/guide/laryngospasm-causes-symptoms-and-treatments#1|title=Laryngospasm |work=Heartburn/GERD Guide|publisher=WebMD|access-date=8 February 2017 }}</ref>


}}
}}

== Further reading ==
{{refbegin}}
* {{cite journal | vauthors = Larson CP | title = Laryngospasm--the best treatment | journal = Anesthesiology | volume = 89 | issue = 5 | pages = 1293–1294 | date = November 1998 | pmid = 9822036 | doi = 10.1097/00000542-199811000-00056 | doi-access = free }}
{{refend}}


== External links ==
== External links ==
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* [http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1947036 Larson, Philip C., "Laryngospam -The Best Treatment", ''Anesthesiology'', 11 1998, Vol.89, 1293–1294]


{{Respiratory pathology}}
{{Respiratory pathology}}
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[[Category:Anesthesia]]
[[Category:Anesthesia]]
[[Category:Larynx disorders]]
[[Category:Larynx disorders]]
[[Category:Otorhinolaryngology]]

Latest revision as of 07:14, 22 March 2024

"Laryngospasms" redirects here. For the parody group, see The Laryngospasms.
Laryngospasm
SpecialtyENT surgery

Laryngospasm is an uncontrolled or involuntary muscular contraction (spasm) of the vocal folds.[1] 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 may be associated with stridor or retractions.

Signs and symptoms[edit]

Laryngospasm is characterized by involuntary spasms of the laryngeal muscles. It is associated with difficulty or inability to breathe or speak, retractions, a feeling of suffocation, which may be followed by hypoxia-induced loss of consciousness.[2] It may be followed by paroxysmal coughing and in partial laryngospasms, a stridor may be heard.[3] It requires prompt identification to avoid possibly fatal complications. It may present with loss of end-tidal carbon dioxide (for mechanically ventilated patients), chest or neck retractions and paradoxical chest wall movements.[3]

The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder inspiration, while exhalation remains easier.[1]

Causes[edit]

Laryngospasm is a primitive protective airway reflex that functions to protect against aspiration. However, it may be detrimental if there is sustained closure of the glottis resulting in blockage of respiration that hinders the free flow of air. 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. [1]

It is most often reported 1) post-operatively after endotracheal extubation or 2) after sudden reflux of gastric contents.[2] [4][1] It is common in drowning. It is estimated that in 10% of cases of drowning as a response to inhalation of water, death occurs due to asphyxia due to laryngospasm without any water in the lungs.[5] It is also a symptom of hypoparathyroidism.[6] It can sometimes occur during sleep, waking up the affected person. These episodic interruptions of sleep have been attributed to acute irritation due to gastro-oesophageal reflux.[2][7] Laryngospasm is also an unlikely but possible side effect of ketamine administration.[8] Laryngospasm may happen in people with neurological disease.[9]

In children, rapid detection and management are imperative to prevent deadly complications such as cardiac arrest, hypoxia and bradycardia.[10]

Patients with a history of significant aspiration, asthma, exposure to airway irritants (smoke, dust, mold, fumes, use of Desflurane), upper respiratory infections, airway anomalies, light anesthesia and patients with acute mental status depression may be at increased risk.[2][4]

Prevention[edit]

When gastroesophageal reflux disease (GERD) is the trigger, treatment of GERD can help manage laryngospasm. Proton pump inhibitors such as Dexlansoprazole (Dexilant), Esomeprazole (Nexium), and Lansoprazole (Prevacid) reduce the production of stomach acids, making reflux fluids less irritant. Prokinetic agents reduce the amount of acid available by stimulating movement in the digestive tract.[2]

Patients who are prone to laryngospasm during illness can take measures to prevent irritation such as antacids to avoid acid reflux.[3]

For acute context, making an upright position of the upper part of the body has been shown to shorten the spasm episodes. Fixation of the arms on stabilization of the body and slowing of breathing is also recommended.[3]

Incidence[edit]

Incidence has been estimated at approximately 1% in both adult and pediatric populations. Its incidence is reported to be more than triple in the very young (birth to 3 months of age), increasing to 10% in those with reactive airways. Other sub-populations with high incidence of laryngospams include patients undergoing tonsillectomy and adenoidectomy (25%).[11]

It is likely that more than 10% of drownings involve laryngospasm, but the evidence suggests that it is not usually effective at preventing water from entering the trachea.[12]

Treatment[edit]

Most minor laryngospasm get better on its own for most people.[1]

Laryngospasm is one of the most common intraoperative complications. It may be life-threatening as it involves reflex closure of the laryngeal muscles and thus results in inability to ventilate the patient.[13] Treatment requires clearing secretions from the oropharynx, applying continuous positive airway pressure with 100% oxygen, followed by deepening the plane of anaesthesia with propofol, and/or paralyzing with succinylcholine.[11]

See also[edit]

References[edit]

  1. ^ a b c d e Gavel G, Walker RW (26 August 2013). "Laryngospasm in anaesthesia". Continuing Education in Anaesthesia, Critical Care & Pain. 14 (2): 47–51. doi:10.1093/bjaceaccp/mkt031.
  2. ^ a b c d e Watson S (11 November 2022). Felson S (ed.). "Laryngospasm". Heartburn/GERD Guide. WebMD. Retrieved 8 February 2017.
  3. ^ a b c d Gdynia HJ, Kassubek J, Sperfeld AD (2006). "Laryngospasm in neurological diseases". Neurocritical Care. 4 (2): 163–167. doi:10.1385/NCC:4:2:163. PMID 16627908. S2CID 37695632.
  4. ^ a b Rogus-Pulia N, Barczi S, Robbins J (2017). "Disorders of swallowing.". In Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, Ritchie C (eds.). Hazzard's Geriatric Medicine and Gerontology (7th ed.). McGraw Hill. ISBN 978-0-07-183345-5.
  5. ^ Barrett KE, Barman SM, Brooks HL, Yuan JJ, eds. (2019). "Regulation of respiration". Ganong's Review of Medical Physiology (26th ed.). McGraw Hill. ISBN 978-1-260-12240-4.
  6. ^ Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, et al. (October 2011). "Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research". Journal of Bone and Mineral Research. 26 (10): 2317–2337. doi:10.1002/jbmr.483. PMC 3405491. PMID 21812031.
  7. ^ Thurnheer R, Henz S, Knoblauch A (September 1997). "Sleep-related laryngospasm". The European Respiratory Journal. 10 (9): 2084–2086. doi:10.1183/09031936.97.10092084. PMID 9311507.
  8. ^ Melendez, Elliot; Bachur, Richard (May 2009). "Serious Adverse Events During Procedural Sedation With Ketamine:". Pediatric Emergency Care. 25 (5): 325–328. doi:10.1097/PEC.0b013e3181a341e0. ISSN 0749-5161.
  9. ^ Gdynia, Hans-Jürgen; Kassubek, Jan; Sperfeld, Anne-Dorte (2006). "Laryngospasm in Neurological Diseases". Neurocritical Care. 4 (2): 163–167. doi:10.1385/NCC:4:2:163. ISSN 1541-6933.
  10. ^ Lobo PE, Hadaya I, Thoeny A (2020). "Anesthesia in head and neck surgery.". In Lalwani AK (ed.). Current Diagnosis & Treatment Otolaryngology—Head and Neck Surgery (4th ed.). McGraw Hill. ISBN 978-0-07-184764-3.
  11. ^ a b Gavel G, Walker RW (April 2014). "Laryngospasm in anaesthesia". Continuing Education in Anaesthesia Critical Care & Pain. 14 (2): 47–51. doi:10.1093/bjaceaccp/mkt031.
  12. ^ North R (December 2002). "The pathophysiology of drowning". South Pacific Underwater Medicine Society Journal. Retrieved 4 October 2020.
  13. ^ Smith EB, Hunsberger J (2021). "Intraoperative complications and crisis management.". In Ellinas H, Matthes K, Alrayashi W, Bilge A (eds.). Clinical Pediatric Anesthesiology. McGraw Hill. ISBN 978-1-259-58574-6.

Further reading[edit]

External links[edit]

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