| Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. | |
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MedLine Citation:
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PMID: 20846964 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The sniffing position is often considered optimal for direct laryngoscopy. Another concept of airway configuration involving a laryngeal vestibule axis and two curves has also been suggested. We investigated whether this theory can be supported mathematically and if it supports the sniffing position as being optimal for direct laryngoscopy. METHODS: Magnetic resonance imaging scans were performed in 42 normal adult volunteers. The airway passage was divided into two curves-primary (oro-pharyngeal curve) and secondary (pharyngo-glotto-tracheal curve). Airway configuration was evaluated in the neutral, extension, head lift, and sniffing positions. The airway passage, point of inflection (where the two curves meet), its tangent, and the line of sight were plotted on each scan. RESULTS: The point of inflection lay within the laryngeal vestibule in all positions. The head lift and sniffing positions caused the tangent to the point of inflection to approximate the horizontal plane. The sniffing, extension, and head lift positions caused a reduction in the area between the line of sight and the airway curve compared with the neutral position. CONCLUSIONS: A two-curve theory is proposed as a basis for explaining airway configuration. The changes in these curves with head and neck positioning support the sniffing position as optimal for direct laryngoscopy. Application of this new concept to other forms of laryngoscopy should be investigated. |
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Authors:
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K B Greenland; M J Edwards; N J Hutton; V J Challis; M G Irwin; J W Sleigh |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-09-15 |
Journal Detail:
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Title: British journal of anaesthesia Volume: 105 ISSN: 1471-6771 ISO Abbreviation: Br J Anaesth Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-18 Completed Date: 2010-11-10 Revised Date: 2011-07-04 |
Medline Journal Info:
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Nlm Unique ID: 0372541 Medline TA: Br J Anaesth Country: England |
Other Details:
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Languages: eng Pagination: 683-90 Citation Subset: IM |
Affiliation:
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Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital Brisbane, Butterfield Street, Herston, Brisbane, Queensland, Australia. french9a@yahoo.co.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anthropometry / methods Female Head / anatomy & histology Head Movements Humans Intubation, Intratracheal / methods Laryngoscopy / methods* Magnetic Resonance Imaging / methods Male Middle Aged Neck / anatomy & histology Patient Positioning* Respiratory System / anatomy & histology* |
| Comments/Corrections | |
Comment In:
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Br J Anaesth. 2011 Jun;106(6):909-10; author reply 910-1
[PMID:
21576102
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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