title: The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children.
abstract: Chin lift and jaw thrust are two common maneuvers used to improve the patency of the upper airway during general anesthesia. We investigated the effect of these maneuvers combined with continuous positive airway pressure (CPAP) on the size of glottic opening and on stridor score. Forty children, aged 2--9 yr, premedicated with midazolam and spontaneously breathing end-tidal 1% halothane and equal parts of nitrous oxide and oxygen, were studied. A flexible fiberoptic bronchoscope was placed via mask and one nostril to the level of the junction of the soft palate and oropharynx. Video recordings and simultaneous stridor scores were obtained during six conditions: 1) chin unsupported, 2) manual chin lift, 3) chin lift and CPAP 10 cm H(2)O, 4) repeat chin unsupported, 5) manual jaw thrust, and 6) jaw thrust and CPAP 10 cm H(2)O. Videos were analyzed to determine the percentage of glottic opening (POGO) score. POGO score increased (P < 0.05) in Conditions 2, 3, 5, and 6. With increasing POGO score there was a decrease in stridor score (P < 0.05).
  
  
  CONCLUSIONS
  Chin lift and jaw thrust maneuvers combined with continuous positive airway pressure improve the view of the glottic opening as viewed by flexible nasal laryngoscopy and decrease stridor in anesthetized, spontaneously breathing children.
authors.affiliation: Department of Anaesthesia, University Children's Hospital of Basel, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Meier
authors.forename: Jeremy
authors.initials: J
authors.lastname: Geiduschek
authors.forename: Reto
authors.initials: R
authors.lastname: Paganoni
authors.forename: Frauke
authors.initials: F
authors.lastname: Fuehrmeyer
authors.forename: Adrian
authors.initials: A
authors.lastname: Reber
mesh_terms: D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D002680:Chin / Q000502:physiology*; D005931:Glottis / Q000502:physiology*; D006801:Humans; D007568:Jaw / Q000502:physiology*; D011175:Positive-Pressure Respiration; D012135:Respiratory Sounds