Document Detail

Sniffing position improves pharyngeal airway patency in anesthetized patients with obstructive sleep apnea.
MedLine Citation:
PMID:  16129972     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Appropriate bag-and-mask ventilation with patent airway is mandatory during induction of general anesthesia. Although the sniffing neck position is a traditionally recommended head and neck position during this critical period, knowledge of the influences of this position on the pharyngeal airway patency is still inadequate. METHODS: Total muscle paralysis was induced with general anesthesia in 12 patients with obstructive sleep apnea, eliminating neuromuscular factors contributing to pharyngeal patency. The cross-sectional area of the pharynx was measured endoscopically at different static airway pressures. Comparison of static pressure-area plot between the neutral and sniffing neck positions allowed assessment of the influence of the neck position change on the mechanical properties of the pharynx. RESULTS: The static pressure-area curves of the sniffing position were above those of neutral neck position, with increasing maximum cross-sectional area and decreasing the closing pressure at both retropalatal and retroglossal airways. The beneficial effects of the sniffing position were greater in obstructive sleep apnea patients with higher closing pressure and smaller body mass index. CONCLUSIONS: Sniffing position structurally improves maintenance of the passive pharyngeal airway in patients with obstructive sleep apnea and may be beneficial for both mask ventilation and tracheal intubation during anesthesia induction.
Shiroh Isono; Atsuko Tanaka; Teruhiko Ishikawa; Yugo Tagaito; Takashi Nishino
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  103     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-30     Completed Date:  2005-10-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  489-94     Citation Subset:  AIM; IM    
Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
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MeSH Terms
Intubation, Intratracheal
Middle Aged
Pharynx / physiology*
Respiratory Mechanics
Sleep Apnea, Obstructive / physiopathology*

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