X-Ray Study of Passage of Air Through the Pharynx in Anæsthetised Patients

Ruben, H; Bentzen, N.; Saev, S

doi:10.1016/s0140-6736(60)90733-9

Cited by 5 publications

(1 citation statement)

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“…Though there is well-documented literature on the relationship of the chin-lift maneuver with airway patency, the relationship between the angle of head-tilt and airway patency has not been defined [ 9 ]. There are conflicting results of studies on the relationship of head extension and airway patency in adults [ 6 , 10 , 11 ]. For newborns, the Neonatal Resuscitation Program (NRP) recommends “sniffing position” (neck flexion with upper cervical extension) for airway patency using a roll under the neck to compensate for the large occiput [ 4 ].…”

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confidence: 99%

Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data

et al. 2016

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Head-tilt maneuver assists with achieving airway patency during resuscitation. However, the relationship between angle of head-tilt and airway patency has not been defined. Our objective was to define an optimal head-tilt position for airway patency in neonates (age: 0–28 days) and young infants (age: 29 days–4 months). We performed a retrospective study of head and neck magnetic resonance imaging (MRI) of neonates and infants to define the angle of head-tilt for airway patency. We excluded those with an artificial airway or an airway malformation. We defined head-tilt angle a priori as the angle between occipito-ophisthion line and ophisthion-C7 spinous process line on the sagittal MR images. We evaluated medical records for Hypoxic Ischemic Encephalopathy (HIE) and exposure to sedation during MRI. We analyzed MRI of head and neck regions of 63 children (53 neonates and 10 young infants). Of these 63 children, 17 had evidence of airway obstruction and 46 had a patent airway on MRI. Also, 16/63 had underlying HIE and 47/63 newborn infants had exposure to sedative medications during MRI. In spontaneously breathing and neurologically depressed newborn infants, the head-tilt angle (median ± SD) associated with patent airway (125.3° ± 11.9°) was significantly different from that of blocked airway (108.2° ± 17.1°) (Mann Whitney U-test, p = 0.0045). The logistic regression analysis showed that the proportion of patent airways progressively increased with an increasing head-tilt angle, with > 95% probability of a patent airway at head-tilt angle 144–150°.

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