Reflex laryngospasm induced by stimulation of distal esophageal afferents

Abstract

Distal esophageal sensory nerves were stimulated in 17 anesthetized dogs divided into three age groups to determine the laryngeal, cardiovascular, and respiratory effects. Group I puppies were 5 to 6 weeks of age, group II puppies were 8 to 19 weeks of age, and group III animals were adult dogs. Marked laryngeal adductor activity and laryngospasm were observed in group II puppies, while no or minimal laryngeal adduction was seen in younger puppies and adult dogs. Mean arterial pressure and heart rate increased significantly in groups II and III (P < .005) but remained unchanged in group I animals (P > .4). This response is distinctly different from the laryngeal chemoreflex because central apnea, hypotension, and bradycardia were absent. The afferent limb of the response is mediated by the vagus nerve as bilateral transthoracic truncal vagotomy eliminated the reflex. The laryngeal response observed following stimulation of distal esophageal afferent fibers may be important in the mechanism of apparent life-threatening events (ALTEs) and the sudden infant death syndrome (SIDS) associated with gastroesophageal reflux disease.

Nasoenteric Tube Complications

“…Laryngeal NET malpositioning may cause an exaggerated superior laryngeal nerve response (30) and overstimulation of distal afferent esophageal fibers (31). During anesthesia, the overall incidence of laryngospasm is 0.87%, increasing to 4.85% with NET presence (32).…”

Prevalence of Gastroesophageal Reflux in Infants with Recurrent Brief Apneic Episodes

“…Apnea may be mediated by distal esophageal afferents and laryngospasm secondary to chemoreflexes (24)(25)(26). In a large prospective study, it was observed that some infants, who later were sudden infant death syndrome victims, had an increased number of brief apneic episodes (27), although the relationship, if any, between the two was not clear.…”

Does magnesium sulfate affect the incidence of respiratory complications in children undergoing esophageal dilatation? An observational pilot study

“…(13) Laryngospasm and upper respiratory tract complications caused by distal afferent esophageal nerve stimulation are observed more frequently in endoscopic procedures involving the esophagus. (14,15) Thus, children who undergo esophageal dilatation have both patient-related and operation-related risks of laryngospasm. In the literature, the incidence of laryngospasm in general pediatric cases is 0.04-14% and as high as 21-27% in tonsillectomy patients.…”