A change in ETT tip orientation from bevel facing left to facing down by 90° CCR, leads to a significantly higher first-attempt success rate by nasal approach in children. We believe the ETT should be rotated before insertion into the nostril to ensure that full 90° CCR of the tip has been accomplished.
Background
We aimed to evaluate if two‐handed mask airway is superior to one‐handed mask airway during inhalational induction of anesthesia in children.
Methods
A randomized, two period, crossover study was performed on 60 children aged 1‐8 years, with obstructive sleep apnea due to adenotonsillar hypertrophy, scheduled for adenotonsillectomy. Children were assigned to two study sequences and one control sequence of 20 subjects each. A control sequence was added to evaluate the effect of anesthetic depth. Sequence 1: One‐handed followed by two‐handed airway, 30 seconds each; Sequence 2: two‐handed followed by one‐handed airway, 30 seconds each and Sequence 3: two‐handed airway, for 60 seconds. The work of breathing indices, phase angle, and labored breathing index were recorded using respiratory inductance plethysmography. Additional outcome measures were tidal volume, minute ventilation, and respiratory rate. A straight comparison and a crossover analysis was performed.
Results
The initial comparison revealed that one‐handed airway had greater phase angle (mean diff. 17.4; 95% confidence interval [CI] 1.07‐33.68; P = .034), greater labored breathing index (mean diff. 0.56; 95% CI 0.16‐1.04; P = .004),lower minute ventilation (mean diff. −1567; 95% CI −2695 to −5.4; P = .004),and lower tidal volume (mean diff. −39; 95% CI −2.7 to −5.4; P = .02) than two‐handed airway. On crossover analysis, within‐subject difference in the phase angle was greater during one‐handed than two‐handed airway (34.3; 95% CI 8.46‐60.14; P = .01) as was labored breathing index (mean diff. 1.2; 95% CI 0.39‐2.00; P < .0046).Minute ventilation was lower during one‐handed than two‐handed airway (mean diff. −3359; 95% CI −4363 to −2355, P < 0.0001) as was tidal volume(mean diff. −78; 95% CI −110.4 to −45.8; P < .0001).
Conclusion
In children with obstructive sleep apnea due to adenotonsillar hypertrophy, two‐handed airway provides superior airway patency that was not influenced by the anesthetic depth.
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