Laryngospasm notch

The laryngospasm notch is located just behind the earlobe. It is bordered by the base of the skull superiorly, the mastoid process posteriorly, and the ramus of the mandible anteriorly. Stimulation of laryngospasm notch can break a laryngospasm and also assist the anesthetist in initiating spontaneous respirations in the sedated patient. When performed properly, the index or middle fingers should be placed in the notch with pressure applied in a medial and cephalad direction. This opens the airway by sliding the mandible forward and produces an extremely painful stimulus, usually resulting in a deep breath. The maneuver is well described by Dr. C. Phillip Larson Jr. in the 3rd edition of Clinical Anesthesiology. The mechanism of action is not well understood, but it may be similar to the "Gate Control Theory" of pain. The powerful stimulus the anesthetist elicits by employing the maneuver may override the nerve impulses telling the vocal cords to adduct.