There were many interesting lectures over the three day session at the American Society of Dentist Anesthesiologists Scientific Session. Here are some highlights applicable to the dental office.

 
"Laryngospasm is the most severe form of vocal cord dysfunction as there is barely if any opening for the air to pass through at all. Often, patients believe they are about to pass out (and sometimes they do), at which point, normal breathing resumes. Literally, their own body is choking itself during laryngospasm and it is a truly frightening experience when it occurs.  (One) manuever that may work is firm pressure in the "laryngospasm notch." Basically, with an attack, quickly with your (or somebody else's) index fingers, press very firmly just behind both your earlobes where there is a notch between the bone of your mastoid process and ear. Press deep and forward towards the nose. It should hurt. If it doesn't hurt, you are not pressing hard enough. The attack should resolve within 10 seconds.

Triggers for these episodes are numerous... stress, allergies, anxiety, asthma exacerbation, reflux, exercise, cold air, etc and even idiopathic.  Christopher Y. Chang, MD"

Laryngospasm can also be caused by too light general anesthesia, too deep sedation, debris on the vocal cords or trauma during endotracheal extubation. Click on the title above to view the entire article.

I don't use a "throat pack" because I believe intubation in the office except for the very young or mentally retarded is an unnecessary risk, but I do want to protect the airway from debris with a "throat screen".  If a 2x2 or 4x4 is used you need floss tied to it.  This sponge has a "tail" that can easily be taped to the cheek out of the way and makes a very good seal.

This is the best I have found so far to reduce the occassional protective reflex cough.  Sold by Xemax.com