Effect of jaw‐thrust manoeuvre on the laryngeal inlet

Murashima, Koji; Fukutome, Takero

doi:10.1111/j.1365-2044.1998.tb00005.x

Cited by 27 publications

(4 citation statements)

References 2 publications

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“…This may be explained by the fact that the jaw thrust manoeuvre was used in all patients to facilitate the insertion of the LMA. The jaw thrust manoeuvre leads to an enlargement of the pharyngeal space by lifting the epiglottis anteriorly (away from the posterior pharyngeal wall), thereby enlarging the laryngeal inlet and improving LMA positioning [15][16][17] . Furthermore, the jaw thrust manoeuvre might have caused the relatively higher success rate of LMA placement in infants at first attempt, particularly in size 1 LMAs (88.8 vs 67% in the study by Dubreuil et al 5 ), while the success rate at first attempt for size 2 LMAs was similar to previous studies (89%) 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Fibreoptic Assessment of Paediatric Sized Laryngeal Mask Airways

Ungern‐Sternberg

Wallace

Sticks

et al. 2010

Anaesth Intensive Care

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Laryngeal mask airways (LMA) are commonly used in paediatric anaesthesia. A well-placed LMA should provide a direct view of the vocal cords facilitating bronchoscopy or fibreoptic intubation. The aim of this audit was to assess the bronchoscopie view of the glottis obtained through an LMA with regard to its size. We prospectively assessed the position of LMAs in relation to the glottic aperture in 350 children (zero to seven years) undergoing elective fibreoptic examination of the upper and/or lower airways. Following induction of anaesthesia and positioning of the LMA, a fibreoptic evaluation of the view of the glottis was performed (complete, partial or no visualisation). Chest movement on manual ventilation was judged as good in the majority of patients and adequate for the remainder. No overt signs of airway obstruction were noted in any patient. However, a complete view of the glottic aperture was present in only 50% of size 1 LMAs, 57.5% of size 1.5, 72.7% of size 2 and 77.8% of size 2.5. The epiglottis impinged on the LMA opening, partially obstructing the view of the glottis in 36.3% of size 1 LMAs, 31.5% of size 1.5, 21% of size 2 and 17.8% of size 2.5. In 13.7% of size 1 LMAs, 11% of size 1.5, 6.3% of size 2 and 4.4% of size 2.5, the epiglottis was completely downfolded, obstructing the view of the glottic aperture. The findings indicate that even if ventilation is judged as adequate, smaller paediatric LMAs are more commonly associated with suboptimal anatomical positioning with partial obstruction of the glottic aperture than larger LMAs, and therefore may require repositioning more often.

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Section: Discussionmentioning

confidence: 99%

Fibreoptic Assessment of Paediatric Sized Laryngeal Mask Airways

Ungern‐Sternberg

Wallace

Sticks

et al. 2010

Anaesth Intensive Care

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“…Operations that are conducted on or in the vicinity of the jaws, in which the mouth is being used for manipulation or insertion of devices, and where there is limited jaw mobility, make usage of a conventional laryngoscope extremely difficult or even impossible ( 1–4 ). Even today, years after the first application of the fiberscope, anesthesiologists still encounter difficulty in intubation in 90% of cases ( 4–7 ).…”

Section: Introductionmentioning

confidence: 99%

“…Some maneuvers such as jaw thrust, head flexion, tongue retraction, and use of intubator airways like Berman and Ovassapian have been successfully used to overcome the aforementioned problems. By pressing on the arytenoid cartilage, air passage can be occluded, as is in Selick's maneuver ( 2 , 6 , 9 , 12 ). Use of intubator laryngeal mask airway (ILMA) is another way to facilitate fiberscopic intubation ( 1 , 11 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of two different methods of fiber-optic nasal intubation: conventional method versus facilitated method (NASAL-18)

Jouryabi

Haghighi

Naderi

et al. 2011

Upsala Journal of Medical Sciences

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ObjectivesAs the conventional fiber-optic nasal intubation technique has several potential difficulties, we compared in this study another technique (NASAL-18) with the conventional one in attempting fiber-optic nasal intubation with a possible higher rate of success.MethodsA randomized controlled trial was carried out at a teaching hospital. Forty-eight patients aged 25–45 years with American Society of Anesthesiologists (ASA) classes I and II undergoing elective faciomaxillary surgery were allocated to two groups of fiberscopic nasal intubation using either the NASAL-18 technique or the conventional method (control). In the NASAL-18 group, a nasal tube was gently inserted into the nasopharynx till mark 18, then a fiberscope with 41 cm length was glided over it and advanced through the nasal cavity till the glottis could be visualized. Finally the nasal tube was rolled over the fiberscope instead of one-step passage of the nasal tube after visualization of glottis in the controls. Times from the start of insertion of the fiberscope into nares till visualization of vocal cord (T1) and from here to complete intubation (T2) were recorded. These times were compared between the two groups.ResultsT1 values in NASAL-18 and control groups were 65.2 ± 33.2 and 151.0 ± 56.5 seconds, respectively (P < 0.0001). T2 durations were measured as 25.1 ± 18.5 and 21.8 ± 10.1 seconds in control and NASAL-18 groups, respectively (P = 0.45). The NASAL-18 group had a success rate of 83% compared to 66.7% in the control group.ConclusionsThe NASAL-18 method reduces the time needed for successful fiber-optic intubation. This method can be added to the list of techniques in facilitating fiber-optic intubation.

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“…Compared to a chin lift, anterior mandibular displacement by jaw thrust generates tension in the suprahyoid muscles, pulling the hyoid bone ventrally against the root of the tongue, and anteriorly displacing the insertion of the genioglossus 19 . These anatomic shifts increase the anteroposterior and transverse diameters of the entire pharyngeal airway, lift the epiglottis from the posterior pharyngeal wall, and reverse the narrowing of the laryngeal inlet 20‐23 . Application of continuous positive airway pressure further improves the airway likely because it works as a pneumatic splint, stiffens the compliant lateral pharyngeal wall, and thus increases the glottis opening 9,24 .…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of one‐handed versus two‐handed mask holding techniques in children during inhalational induction of anesthesia: A randomized crossover study

Choudhry

Brenn

Sacks

et al. 2021

Pediatric Anesthesia

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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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Effect of jaw‐thrust manoeuvre on the laryngeal inlet

Cited by 27 publications

References 2 publications

Fibreoptic Assessment of Paediatric Sized Laryngeal Mask Airways

Fibreoptic Assessment of Paediatric Sized Laryngeal Mask Airways

Comparison of two different methods of fiber-optic nasal intubation: conventional method versus facilitated method (NASAL-18)

Comparative evaluation of one‐handed versus two‐handed mask holding techniques in children during inhalational induction of anesthesia: A randomized crossover study

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