The Endoscopically Measured Effects of Airway Maneuvers and the Lateral Position on Airway Patency in Anesthetized Children with Adenotonsillar Hypertrophy

Abstract

Obstruction of the upper airway is a major challenge for anesthesiologists administering general anesthesia in spontaneously breathing children with adenotonsillar hypertrophy. Lateral positioning is a simple treatment for obstructive sleep apnea. In this study, we examined the effects of body position shifting and common airway maneuvers such as chin lift and jaw thrust on airway patency (stridor score and upper airway dimensions by endoscopy) in anesthetized children scheduled for adenotonsillectomy. Eighteen children aged 1-11 yr were anesthetized with sevoflurane. During spontaneous breathing with 5% sevoflurane and 100% oxygen, upper airway dimensions and stridor score were recorded. After baseline recording, chin lift and jaw thrust were performed in both the supine and the lateral decubitus position. Chin lift, jaw thrust, and lateral position increased the airway dimensions and improved the stridor score. Moreover, lateral positioning enhanced the effects of these airway maneuvers on airway patency. We concluded that lateral positioning combined with airway maneuvers provided better airway patency for anesthetized children with adenotonsillar hypertrophy.

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

“…A more neutral position may be useful in children under two years of age and a pillow or rolled towel under the child's shoulders may improve airway patency and access to the tracheostomy . The lateral position may be of benefit in some children, especially if there is known upper airway obstruction, although this position may limit access to the anterior neck .…”

The effects of Anesthesia and opioids on the upper airway: A systematic review

“…Sevoflurane has dose‐dependent effects, with decreasing phasic inspiratory genioglossus activity seen with increasing depth of sevoflurane anesthesia and no difference in tonic activity . Sevoflurane can also decrease airway patency, especially during inspiration . In a study using both sevoflurane and nitrous oxide for induction and propofol for anesthesia maintenance, the greatest narrowing was seen at the soft palate level, and the airway dimensions changed when sedated versus awake.…”

“…45 Sevoflurane can also decrease airway patency, especially during inspiration. [46][47][48] In a study using both sevoflurane and nitrous oxide for induction and propofol for anesthesia maintenance, the greatest narrowing was seen at the soft palate level, and the airway dimensions changed when sedated versus awake. Despite this, the total cross-sectional area was unchanged.…”

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in Paediatrics

“…[36] Lateral position should be considered in the presence of adenotonsillar hypertrophy or lingual tonsil or when mask ventilation is not improved by other techniques described here in supine position. [7] Airway adjuncts such as correct sizes of oropharyngeal and nasopharyngeal airways may be helpfulVentilation with two-person bag-mask technique should be considered when face mask ventilation is difficult. This is particularly useful in children who are obese, syndromic and have micrognathia…”