title: Sniffing position improves pharyngeal airway patency in anesthetized patients with obstructive sleep apnea.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan. isonos-chiba@umin.ac.jp
authors.forename: Shiroh
authors.initials: S
authors.lastname: Isono
authors.forename: Atsuko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Yugo
authors.initials: Y
authors.lastname: Tagaito
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishino
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009333:Neck; D010614:Pharynx / Q000502:physiology*; D011187:Posture; D015656:Respiratory Mechanics; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*