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PEDIATRIC ANESTHESIA

The Effect of Chin Lift, Jaw Thrust, and Continuous Positive Airway Pressure on the Size of the Glottic Opening and on Stridor Score in Anesthetized, Spontaneously Breathing Children

Sonja Meier, MD^*, Jeremy Geiduschek, MD, Reto Paganoni, MD^*, Frauke Fuehrmeyer, MD^*, and Adrian Reber, MD^*

*Department of Anaesthesia, University Children’s Hospital of Basel, Switzerland; and Department of Anesthesiology, University of Washington School of Medicine and Children’s Hospital and Regional Medical Center, Seattle, Washington

Address correspondence and reprint requests to Adrian Reber, MD, PhD, Department of Anaesthesia, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland. Address e-mail to adrian.reber{at}unibas.ch

Chin lift and jaw thrust are two common maneuvers used to improve the patency of the upper airway during general anesthesia. We investigated the effect of these maneuvers combined with continuous positive airway pressure (CPAP) on the size of glottic opening and on stridor score. Forty children, aged 2–9 yr, premedicated with midazolam and spontaneously breathing end-tidal 1% halothane and equal parts of nitrous oxide and oxygen, were studied. A flexible fiberoptic bronchoscope was placed via mask and one nostril to the level of the junction of the soft palate and oropharynx. Video recordings and simultaneous stridor scores were obtained during six conditions: 1) chin unsupported, 2) manual chin lift, 3) chin lift and CPAP 10 cm H₂O, 4) repeat chin unsupported, 5) manual jaw thrust, and 6) jaw thrust and CPAP 10 cm H₂O. Videos were analyzed to determine the percentage of glottic opening (POGO) score. POGO score increased (P < 0.05) in Conditions 2, 3, 5, and 6. With increasing POGO score there was a decrease in stridor score (P < 0.05).

IMPLICATIONS: Chin lift and jaw thrust maneuvers combined with continuous positive airway pressure improve the view of the glottic opening as viewed by flexible nasal laryngoscopy and decrease stridor in anesthetized, spontaneously breathing children.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999