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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Sniffing position combined with mouth opening improves facemask ventilation in children with adenotonsillar
1Department of Anaesthesia and Intensive Care Medicine, Ankara Training and Research Hospital, Turkey. ozguncuvas@yahoo.com
Insights
The sniffing position with an open mouth improves ventilation effectiveness in paralyzed pediatric patients during anesthesia. This technique enhances expired tidal volume and reduces peak inspiratory pressure for safer facemask ventilation.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Facemask ventilation effectiveness is crucial in pediatric patients undergoing adenotonsillectomy.
- Paralyzed pediatric patients present unique challenges for airway management.
- Optimizing ventilation strategies is essential for patient safety during anesthesia.
Purpose of the Study:
- To evaluate the influence of sniffing position combined with mouth opening on facemask ventilation.
- To compare ventilation effectiveness across different head and neck positions in paralyzed pediatric patients.
- To determine the impact of head positioning on expired tidal volume and airway pressures.
Main Methods:
- Prospective randomized study of 40 pediatric patients (5-11 years) undergoing adenotonsillectomy.
- Anesthesia induced with sevoflurane and N(2)O-O(2) mixture; patients were paralyzed with vecuronium.
- Three ventilation positions tested: closed mouth-neutral (CN), closed mouth-sniffing (CS), and open mouth-sniffing (OS).
Main Results:
- The open mouth-sniffing (OS) position significantly increased expired tidal volume (V(Texp)) compared to closed mouth-neutral (CN).
- OS position resulted in significantly lower peak inspiratory pressure (PIP) compared to both CN and CS positions.
- Facemask ventilation in the OS position demonstrated reduced air leakage.
Conclusions:
- Combining sniffing position with mouth opening optimizes facemask ventilation in paralyzed pediatric patients.
- This technique improves expired tidal volume and reduces peak inspiratory pressure during sevoflurane-N(2)O anesthesia.
- The OS position enhances ventilation efficiency and reduces leakage, contributing to improved patient safety.
Background:
This study evaluates the influence of sniffing position combined with mouth opening on the effectiveness of facemask ventilation in paralyzed pediatric patients undergoing adenotonsillectomy during sevoflurane-N(2)O anesthesia.
Methods:
After Institutional Ethics Committee approval, 40 children 5-11 years of age who were scheduled for an elective adenotonsillectomy operation were enrolled in this prospective randomized study. After routine monitoring and pre-oxygenation, anesthesia was induced with sevoflurane 8% in a mixture of 50% N(2)O-O(2). Three minutes after the administration of vecuronium, the sequence of the positions was randomized. Three positions were applied during facemask ventilation: Position CN (closed mouth - neutral head and neck position), position CS (closed mouth-sniffing position) and position OS (opened mouth-sniffing position). Volume-controlled ventilation was started. Peak inspiratory pressure (PIP), tidal volume (V(T)), expired tidal volume (V(Texp)) and end-tidal CO(2) pressure were recorded. The percent of leakage was calculated. The primary endpoint of this study was the expired tidal volume (V(Texp)).
Results:
There was a statistically significant difference among the three positions for V(Texp) and PIP values. The OS resulted in higher V(Texp) values when compared with CN (P=0.022). The OS was significantly better than the other two positions, resulting in lower PIP values (P<0.001 and P=0.004, for CN and CS, respectively). The OS also resulted in less leakage during facemask ventilation when compared with CN and CS.
Conclusions:
Sniffing position combined with mouth opening improves V(Texp) and PIP values during facemask ventilation during sevoflurane-N(2)O anesthesia in paralyzed pediatric patients with adenotonsillar hypertrophy.
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