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PEDIATRIC ANESTHESIA

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

Young-Chang P. Arai, MD^*, Kayo Fukunaga, MD^*, Wasa Ueda, MD, Masashi Hamada, MD, Hiroyuki Ikenaga, MD, and Kei Fukushima, MD

*Department of Anesthesiology, Kochi Medical School, Oko-Cho, Nankoku city, Kochi, Japan; Departments of Anesthesiology, Clinical Physiology and Pharmacology, School of Nursing, Department of Otolaryngology, Kochi Medical School, Kochi, Japan

Address correspondence and reprint requests to Young-Chang P. Arai, Department of Anesthesiology, Kochi Medical School, Oko-Cho, Nankoku, Kochi, 783–8505, Japan. Address e-mail to arainon{at}med.kochi-ms.ac.jp.

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.

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