Head position angles to open the upper airway differ less with the head positioned on a support

Mitterlechner, Thomas; Paal, Peter; Kuehnelt-Leddhin, Lukas; Strasak, Alexander; Pütz, G.; Gravenstein, Nikolaus; Goedecke, Achim von; Wenzel, Volker

doi:10.1016/j.ajem.2012.06.007

Cited by 6 publications

(8 citation statements)

References 15 publications

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“…In contrast to previous studies, tidal volumes were compared when the head was positioned on a cushion and without a cushion (6). In our patients the lowest, although not significant, mean peak airway pressure was observed in the group with no cushion support when the head was maximally extended.…”

Section: Discussioncontrasting

confidence: 82%

“…Studies in adults during midazolam sedation (19) or propofol anaesthesia (with muscle relaxation) (20) showed that head extension decreased upper airway collapsibility and closing pressures, respectively. A previous study suggested that employing a cushion support improves bag-valve mask ventilation, yet different PEEP levels between groups prevented a robust conclusion (6).…”

Section: Discussionmentioning

confidence: 99%

“…The oral, pharyngeal, and tracheal axes form a better alignment when the head is positioned on a support (12). In fact, in the operating theatre, positioning of the head on a cushion support is commonly done to improve mask ventilation (6). Current European resuscitation council guidelines recommend head tilt, chin lift and jaw thrust, as well as a two-hand technique for bag-valve mask ventilation to improve the patency of an obstructed airway (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, when keeping peak airway pressure low during bag-valve mask ventilation, the risk for stomach inflation is minimized. Routine clinical practice in the operating theatre and a previous study suggests that bagvalve mask ventilation could be improved when the head is positioned on a support (6). Furthermore, Kobayashi et al showed that during propofol anesthesia a head elevation of six centimeters decreased upper airway collapsibility (7).…”

Section: Introductionmentioning

confidence: 99%

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Effects of Head Extension on Peak Airway Pressure During Mask-Ventilation: A Prospective, Randomized, Clinical Single-Centre Trial

Fiala¹,

Kroess²,

Neururer³

et al. 2017

Ann Anesth Crit Care

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Background: Rescuers with basic skills may have difficulties to perform efficient and safe mask ventilation. This study aimed at determining the best head position for ventilation, while avoiding stomach inflation. Methods: Forty healthy patients were mechanically ventilated with a face mask (7 mL.kg-1). The head was positioned either with n = 20 or without a cushion support (n = 20), and in three different head extension positions. Results: Head angles differed more with no cushion support at 12°; 95% CI 6-18°), 25°(95% CI 17-33°) and 32°(95% CI 27-37°); P < 0.05) when compared with cushion support at 5°(95% CI 3-7°), 16°(95% CI 13-20°), and 22°(95% CI 18-26°); P < 0.05. Without cushion support, peak airway pressure in neutral position was higher (20 cmH2O, 95% CI 17 to 23 cmH2O) than in the anesthesiologist's favorite position (16 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000) or in extension (16 ± 7 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000). Stomach inflation correlated with body mass index in the neutral position, and in the anesthesiologist's preferred position without cushion support. Conclusions: Our data suggested that maximal head extension with no cushion support yields the lowest and thus safest peak airway pressure during mask ventilation.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Head Extension on Peak Airway Pressure During Mask-Ventilation: A Prospective, Randomized, Clinical Single-Centre Trial

Fiala¹,

Kroess²,

Neururer³

et al. 2017

Ann Anesth Crit Care

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“…Although the evidence is sparse, the sniffing position appears to be beneficial for improving upper airway patency 106 and facilitating FMV. 107 Positioning for SGA insertion . Product monographs for SGAs typically espouse a sniffing position for insertion, with head extension and lower neck flexion.…”

Section: Implementation Of the Planned Strategy When Difficult Tracheal Intubation Is Predictedmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

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Atemwegsmanagement

Düsterwald,

Doll,

Pott

et al. 2023

Atemwegsmanagement Und Narkose in Notfall- Und Akutmedizin

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Head position angles to open the upper airway differ less with the head positioned on a support

Cited by 6 publications

References 15 publications

Effects of Head Extension on Peak Airway Pressure During Mask-Ventilation: A Prospective, Randomized, Clinical Single-Centre Trial

Effects of Head Extension on Peak Airway Pressure During Mask-Ventilation: A Prospective, Randomized, Clinical Single-Centre Trial

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Atemwegsmanagement

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