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PEDIATRIC ANESTHESIA

The Effects of Common Airway Maneuvers on Airway Pressure and Flow in Children Undergoing Adenoidectomies

Heinz Bruppacher, MD^*, Adrian Reber, MD PhD^*, Jürg P. Keller, PhD, Jeremy Geiduschek, MD, Thomas O. Erb, MD MHS^*, and Franz J. Frei, MD^*

*Division of Pediatric Anesthesia, University Children’s Hospital Beider Basel, Basel, Switzerland; Fachtechnische Hochschule, Oensingen, 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 Franz J. Frei, MD, Division of Pediatric Anesthesia, University Children’s Hospital Beider Basel, Römergasse 8, CH-4058 Basel, Switzerland. Address e-mail to Franz-J.Frei{at}unibas.ch

Obstruction of the upper airway occurs frequently in anesthetized, spontaneously breathing children, especially in those with adenoidal hyperplasia. To improve airway patency, maneuvers such as chin lift (CL), jaw thrust (JT), and continuous positive airway pressure (CPAP) are often used. In this study, we examined the comparative efficacy of these maneuvers in children scheduled to undergo adenoidectomy. Sixteen children aged 2–9 yr were anesthetized with sevoflurane. During spontaneous breathing, the flows and pressures in the mask (ma), oropharynx (op), and esophagus (es) were measured simultaneously, and maximal pressure differences during inspiration (P) were calculated. After baseline recording, CL and JT maneuvers were performed in random order without and with CPAP (5 cm H₂O). The observed P_ma - P_es of 12.3 ± 3.4 cm H₂O at baseline decreased with all airway maneuvers (P < 0.05). This resulted from decreases of P_ma - P_op (P < 0.05) and P_op - P_es (P < 0.05) in all interventions except CL, in which P_ma - P_op remained similar. In contrast, significant improvements of minute ventilation and maximal inspiratory peak flow (P > 0.05) were observed only with JT (with and without CPAP). We conclude that CL may improve airway patency and ventilation, whereas JT with or without CPAP was the most effective maneuver to overcome airway obstruction in children with adenoidal hyperplasia.

IMPLICATIONS: Airway maneuvers are often used in anesthetized children to relieve airway obstruction during spontaneous ventilation. Compared with chin lift and continuous positive airway pressure, the jaw thrust maneuver was the most effective to improve airway patency and ventilation in children undergoing adenoidectomy.

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