In Reply:-Dr. Rajan suggests that the treatment I proposed for laryngospasm works only for supraglottic but not for glottic obstruction. This is true if the pressure is applied to the ramus of the mandible anywhere below the laryngospasm notch. To be effective, the operator must be cephalad enough to feel the base of the skull as inward pressure is applied. I would not recommend attempting direct laryngoscopy as a treatment for laryngospasm because it is unnecessary, time-consuming, often ineffective, and potentially traumatic to the larynx. Dr. Johnstone's theory of bending the styloid process and producing periosteal pain as an explanation for why pressure in the "laryngospasm notch" reverses laryngospasm is as valid as any proposed by me. In addition, once one is experienced and comfortable with the technique, firm pressure on one "notch" while holding the mask with the other hand is effective. If unilateral pressure should fail, I recommend returning to bilateral pressure and, if necessary, having an assistant hold the mask as Dr. Johnstone suggests.

C. Philip Larson, Jr, M.D.

Professor of Clinical Anesthesiology; UCLA School of Medicine; Los Angeles, California;

(Accepted for publication March 18, 1999.)