Hiccups with lma

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dabears505

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Anyone ever have this? What do you guys do?
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Amazing trick I learned on this board (@FFP maybe?):

Pass an NT suction cath or NPA into the back of the nasopharynx. This tickles something that breaks the hiccup reflex arc (you’re welcome for the highly technical description of the mechanism of action). Anyways, I kind of poo-poo’d it until I had an opportunity to try it. It’s magical.
 
SaltyDog said:
Amazing trick I learned on this board (@FFP maybe?):

Pass an NT suction cath or NPA into the back of the nasopharynx. This tickles something that breaks the hiccup reflex arc (you’re welcome for the highly technical description of the mechanism of action). Anyways, I kind of poo-poo’d it until I had an opportunity to try it. It’s magical.
Click to expand...

I do this for MAC cases when patient hiccups. Lubed up nasal airway, works instantaneously and quite magical.

For the LMA placement I would first ensure patient is deep enough and LMA is well seated before doing that
 
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Usually it happens if patient wasn't deep enough during LMA placement.

I will try those tricks!!!!
 
I give 1-2 cc of sux. It seems to stop them, and KEEP them stopped, and they start breathing again in a couple of minutes. Only issue I ever had was that one of them was the ONLY pt I’ve ever had that complained of myalgias.
 
Try salty approach first. If not, 1cc sux.

I did it a week ago. 1cc sux stopped breathing for 2mins.
 
DirtDocMD said:
I give 1-2 cc of sux. It seems to stop them, and KEEP them stopped, and they start breathing again in a couple of minutes. Only issue I ever had was that one of them was the ONLY pt I’ve ever had that complained of myalgias.
Click to expand...
I feel like I've read somewhere that a higher dose of sux is associated with decreased inference of myalgias.
 
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SaltyDog said:
Amazing trick I learned on this board (@FFP maybe?):

Pass an NT suction cath or NPA into the back of the nasopharynx. This tickles something that breaks the hiccup reflex arc (you’re welcome for the highly technical description of the mechanism of action). Anyways, I kind of poo-poo’d it until I had an opportunity to try it. It’s magical.
Click to expand...

Also learned it here and makes you look like a magician in the Gi suite. Apparently our surgery service had a patient with bad hiccups on the floor recently. Really wanted to try a nasal airway but it had resolved by the time i heard about it.
 
Think it would work in an awake patient? I assume you can't topicalise the airway or it won't work?
 
secretasianman said:
Didn’t know about this cool trick. Now if you can tell me how to reliably produce hiccups Ill be even more impressed.
Click to expand...

Lit suggests stim of pharyngx opposite c2 and c3, or perhaps effect on sphenopalantine ganglia. Many use lidocaine jelly, but ive done with regular lube with the same effect so it isn't necessarily anesthetizing a set of nerves

Edit; misread what u wrote. I dont know how to reliably produce hiccups
 
SaltyDog said:
Amazing trick I learned on this board (@FFP maybe?):

Pass an NT suction cath or NPA into the back of the nasopharynx. This tickles something that breaks the hiccup reflex arc (you’re welcome for the highly technical description of the mechanism of action). Anyways, I kind of poo-poo’d it until I had an opportunity to try it. It’s magical.
Click to expand...

It's from the tips and tricks thread

forums.studentdoctor.net

Tips and Tricks

Everyone has their own little semi-secret tricks. Let's hear what yours are. Maybe this thread will suck, and maybe it'll be great. We'll see. I'll throw 2 out there. 1) Your pt has very crappy veins, and you need a reasonable IV? Got an ultrasound, found a nice juicy target but it's pretty...
forums.studentdoctor.net forums.studentdoctor.net
 
anbuitachi said:
yea, so why are you trying to stimulate the phrenic nerve by putting a tube there?
Click to expand...

I don’t know why it works. I don’t even know why hiccoughs exist. Just saying anatomically the origin of the phrenic is close to the nasopharynx and somehow touching the nasopharynx interrupts automatic firing of the phrenic nerve.

My point about the letter from Stanford is that they published it in A&A instead of posting it on SDN. That’s how you become a professor. You can’t list SDN posts on your CV😉
 
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anbuitachi said:
yea, so why are you trying to stimulate the phrenic nerve by putting a tube there?
Click to expand...
It's 3-5. And it's all anecdotal speculation anyway. Maybe it interferes with phrenic efferents....maybe there's a gating phenomenon going on. Personally I just avoid naked versed for a pre-op (mix it with fentanyl or something) if I give it at all and avoid the problem mostly altogether.
 
drmwvr said:
It's 3-5. And it's all anecdotal speculation anyway. Maybe it interferes with phrenic efferents....maybe there's a gating phenomenon going on. Personally I just avoid naked versed for a pre-op (mix it with fentanyl or something) if I give it at all and avoid the problem mostly altogether.
Click to expand...

?

Why versed?
Some patients hiccup from propofol
 
nimbus said:
I don’t know why it works. I don’t even know why hiccoughs exist. Just saying anatomically the origin of the phrenic is close to the nasopharynx and somehow touching the nasopharynx interrupts automatic firing of the phrenic nerve.

My point about the letter from Stanford is that they published it in A&A instead of posting it on SDN. That’s how you become a professor. You can’t list SDN posts on your CV😉
Click to expand...

you arent a professor yet?
 
coffeebythelake said:
?

Why versed?
Some patients hiccup from propofol
Click to expand...
Yep...true...IME have less trouble with it if I give a good pre-med, that is mitigating or avoiding one more medicine that I know can cause hiccups.
 
drmwvr said:
It's 3-5. And it's all anecdotal speculation anyway. Maybe it interferes with phrenic efferents....maybe there's a gating phenomenon going on. Personally I just avoid naked versed for a pre-op (mix it with fentanyl or something) if I give it at all and avoid the problem mostly altogether.
Click to expand...
I echo this.....sure it may happen with propofol but more often the culprit is versed. You’re quite literally getting the patient drunk. Nowadays I’ve found myself just avoiding using versed altogether. Patients also seem to wake up faster and with a clearer head, especially my old folks.
 
Twiggidy said:
I echo this.....sure it may happen with propofol but more often the culprit is versed. You’re quite literally getting the patient drunk. Nowadays I’ve found myself just avoiding using versed altogether. Patients also seem to wake up faster and with a clearer head, especially my old folks.
Click to expand...

Evidence for this? I'm not convinced versed causes hiccups. And no you are not literally making patient drunk with benzodiazepines.
 
versed for an lma case? i dont really understand that but ok... why bother like?

10mg roc fixes all things. 1 - lma sits better, faster insertion and lowers dose of ppf needed. 2 stops hiccups. 3 such a low dose doesnt stop spont vent and rarely needs reversal.

Theres studies on these things
 
SaltyDog said:
Amazing trick I learned on this board (@FFP maybe?):

Pass an NT suction cath or NPA into the back of the nasopharynx. This tickles something that breaks the hiccup reflex arc (you’re welcome for the highly technical description of the mechanism of action). Anyways, I kind of poo-poo’d it until I had an opportunity to try it. It’s magical.
Click to expand...

This works most of the time ! I learned it from an surgicenter guy who places thousands of LMAs every year.
 
I’ve paralyzed to stop hiccups in the past and had them come right back as soon as the patient was reversed.
 
there's a letter to the editor somewhere that suggests 10 of reglan. n=1 for me. usually just a big slug of prop works.
 
In everyday life to stop hiccups I usually hold my breath for 30 seconds. I learned this in middle school. N=1, 85% efficacy. The remaining 15% I repeat the above.

Some say “drink from the other side of the glass.”

I would think this works by not stimulating the phrenic nerve/diaphragm. This could stop the nerve irritation or muscle excitability causing the hiccups. If pt can tolerate some apnea with an lma, I think a bolus of propofol, 30 seconds of apnea, then put them on pressure control or bag them until they start breathing again would be worth a shot. A static diaphragm would be the goal.
 
Hiccups are essentially involuntary diaphragmatic contractions. When this happens to any other muscle, we call it a cramp. Treatment is the same - stretch it out. That means a full tidal exhale and hold it as long as you can. Or stick a CTA in your nose.
 
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