title: Sniffing position combined with mouth opening improves facemask ventilation in children with adenotonsillar hypertrophy.
abstract: BACKGROUND
  This study evaluates the influence of sniffing position combined with mouth opening on the effectiveness of facemask ventilation in paralyzed pediatric patients undergoing adenotonsillectomy during sevoflurane-N(2)O anesthesia.
  
  
  METHODS
  After Institutional Ethics Committee approval, 40 children 5-11 years of age who were scheduled for an elective adenotonsillectomy operation were enrolled in this prospective randomized study. After routine monitoring and pre-oxygenation, anesthesia was induced with sevoflurane 8% in a mixture of 50% N(2)O-O(2). Three minutes after the administration of vecuronium, the sequence of the positions was randomized. Three positions were applied during facemask ventilation: Position CN (closed mouth - neutral head and neck position), position CS (closed mouth-sniffing position) and position OS (opened mouth-sniffing position). Volume-controlled ventilation was started. Peak inspiratory pressure (PIP), tidal volume (V(T)), expired tidal volume (V(Texp)) and end-tidal CO(2) pressure were recorded. The percent of leakage was calculated. The primary endpoint of this study was the expired tidal volume (V(Texp)).
  
  
  RESULTS
  There was a statistically significant difference among the three positions for V(Texp) and PIP values. The OS resulted in higher V(Texp) values when compared with CN (P=0.022). The OS was significantly better than the other two positions, resulting in lower PIP values (P<0.001 and P=0.004, for CN and CS, respectively). The OS also resulted in less leakage during facemask ventilation when compared with CN and CS.
  
  
  CONCLUSIONS
  Sniffing position combined with mouth opening improves V(Texp) and PIP values during facemask ventilation during sevoflurane-N(2)O anesthesia in paralyzed pediatric patients with adenotonsillar hypertrophy.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Ankara Training and Research Hospital, Turkey. ozguncuvas@yahoo.com
authors.forename: O
authors.initials: O
authors.lastname: Cuvas
authors.forename: B
authors.initials: B
authors.lastname: Dikmen
authors.forename: F
authors.initials: F
authors.lastname: Yucel
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000473:pathology*; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008397:Masks; D008738:Methyl Ethers / Q000008:administration & dosage; D009055:Mouth; D014066:Palatine Tonsil / Q000473:pathology*; D010366:Peak Expiratory Flow Rate; D011187:Posture; D011229:Preanesthetic Medication; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D000077149:Sevoflurane; D013990:Tidal Volume; D014068:Tonsillectomy
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane