Document Detail

Lengthening of the trachea during neck extension: which part of the trachea is stretched?
MedLine Citation:
PMID:  18713918     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We sought to determine the distances of the three segments of the airway from upper incisors to carina in intubated patients in three different neck positions. METHODS: Twenty patients undergoing elective surgery were studied. The airway was divided into three segments: upper incisor to vocal cords (UI-VC), vocal cords to sternal notch (VC-SN), and sternal notch to the carina (SN-CA). After general anesthesia and tracheal tube placement, the circuit was connected and the lungs ventilated. A bronchoscope was inserted through a ported elbow adapter until the tip just contacted carina. A marker tape was placed on the bronchoscope immediately above the adapter port. As the bronchoscope was withdrawn to the sternal notch (by transillumination), vocal cords and upper incisor (endoscopic visualization), three corresponding markers were placed along the bronchoscope. The three segments of the airway were obtained by measuring the distances between the four markers. Measurements were taken with the patient's neck in flexion (10 cm pillow), neutral (5 cm pillow), and extension (no pillow) positions. Repeated measure analysis of variance and paired t-tests were used for analysis of the data. RESULTS: The UI-VC, VC-SN, and SN-CA distances were 12.01 +/- 1.49, 5.37 +/- 0.95, 8.24 +/- 1.16 cm. From neck flexion to extension, UI-VC and VC-SN increased by 0.36 +/- 0.68 cm (P = 0.027) and 1.74 +/- 0.48 cm (P < 0.001) respectively; SN-CA decreased by 0.12 +/- 0.70 cm (NS). Overall, UI-CA increased by 1.99 +/- 0.70 cm (P < 0.001). SN-CA represented 64%, 61%, 56% of the VC-CA distance with the neck in flexion, neutral, and extension respectively. SN-CA did not change significantly among the head positions (NS). CONCLUSIONS: From neck flexion to extension, the UI-CA distance increased by 1.99 cm. The major contribution to this lengthening was an increase of the VC-SN distance by 1.74 cm; UI-VC increased by 0.36 cm whereas SN-CA did not change significantly. Averaging the three neck positions, SN-CA represented 60% of the VC-CA distance. Our findings may explain why tracheal tubes fixed at the mouth ascend in the trachea with neck extension.
David T Wong; Hao Weng; Eunice Lam; Hai-Bao Song; Jin Liu
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  107     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-20     Completed Date:  2008-09-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  989-93     Citation Subset:  AIM; IM    
Department of Anesthesiology, Toronto Western Hospital, University of Toronto, MC2-405 Toronto, Ontario M5T 258, Canada.
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MeSH Terms
Bronchoscopy / methods
Intubation, Intratracheal / methods*
Models, Anatomic
Neck / anatomy & histology
Reference Values
Trachea / anatomy & histology*,  pathology*
Vocal Cords / anatomy & histology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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