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PEDIATRIC ANESTHESIA

The Effects of Chin Lift and Jaw Thrust While in the Lateral Position on Stridor Score in Anesthetized Children with Adenotonsillar Hypertrophy

Young-Chang P. Arai, MD^*, Kayo Fukunaga, MD, Seiji Hirota, MD, and Shoji Fujimoto, MD

*Department of Anesthesiology, Kochi Municipal Hospital; and Department of Anesthesiology, Kochi Medical School, Kochi, Japan

Address correspondence and reprint requests to Young-Chang P. Arai, MD, 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 patients, especially in pediatric anesthesia with adenotonsillar hypertrophy. Lateral positioning is a simple treatment for obstructive sleep apnea and also decreases collapsibility of the pharynx in anesthetized adults with 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) in anesthetized children scheduled for adenotonsillectomy. Thirty children aged 1–10 yr were anesthetized with sevoflurane. During spontaneous breathing of 5% sevoflurane, stridor score was recorded. After baseline recording, chin lift and jaw thrust were performed on patients in both the supine and the lateral decubitus positions. Chin lift and jaw thrust improved the stridor score. Furthermore, lateral positioning dramatically enhanced the effects of these airway maneuvers on airway patency. Jaw thrust combined with lateral positioning provided easy airway management for the anesthesiologists. We conclude that lateral positioning combined with airway maneuvers significantly improved airway patency compared with the airway maneuvers alone for patients in the supine position.

IMPLICATIONS: We investigated the effects of body position shifting and airway maneuvers on airway patency in anesthetized children scheduled for adenotonsillectomy. Lateral positioning not only improved airway patency but also enhanced the potential of airway maneuvers.

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