title: [Comparison of jaw thrust and trapezius squeezing test as indicators for laryngeal mask airway insertion in infants and young children].
abstract: OBJECTIVE
  To compare the effectiveness of the jaw thrust and the trapezius squeezing test(TST) for laryngeal mask airway (LMA) insertion in infants and children under sevoflurane anesthesia.
  
  
  METHODS
  A total of 100 children aged from 6 month to 3 years, American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ and undergoing minor operation were enrolled from January to June 2015 in Tianjin Children's Hospital. The patients were randomly divided into jaw thrusting group (Group J, n=50)and trapezius squeezing group(Group T, n=50). Anesthesia was induced with sevoflurane. When children's eyelash reflex lose, jaw thrust/trapezius squeeze was applied every 15 seconds.It's considered that the depth of anesthesia was not enough, and test reaction was positive if any movements of body, limbs or toes were found at the point of test. Sevoflurane should be keep on inhalation until negative test reaction was appeared. Then LMA was inserted immediately.The time required for the negative test, end-tidal sevoflurane concentrations (ETsev), the index of Narcotrend anesthesia monitor(NT), the occurrence of gross purposeful movements, coughing, gagging, breath-holding, laryngospasm or an SpO2 < 90% during LMA insertion in two groups of patients were observed and recorded. The condition of LMA insertion and the rate of successful insertion were evaluated. The blood pressure(BP), heart rate(HR) and SpO2 were also recorded before and after LMA insertion.
  
  
  RESULTS
  In group J and group T, the time required for the negative test was (2.31±1.03) vs (2.85±0.97)min(t=-2.462, P<0.05), ETsev was(3.25±1.02)% vs (3.81±0.87) %(t=-2.361, P<0.05), the depth of anesthesia NT index was(50.41±5.38) vs (41.32±4.92)(t=3.021, all P<0.05). All of above results were significantly different. The successful rate of the first attempt LMA insertion was 78% vs 100%(χ(2)=12.36 , P<0.01), respectively. The differences had statistical significance. The conditions of LMA insertion in group T were superior to those in group J. The incidences of gross purposeful movements, coughing, gagging, breath-holding and SpO2<90% during LMA insertion in group J were 20%, 16%, 10%, 14% and 8%, which were higher than those in group T (2%, 2%, 0, 2%, 0), the differences were significant(χ(2)=8.27, 5.98, 5.26, 4.89, 4.17, all P<0.05). No significant change in blood pressure, heart rate and SpO2 were found before and after inserting LMA in two groups.
  
  
  CONCLUSIONS
  The trapezius squeezing test is a superior indicator of adequate condition for LMA insertion compared to the jaw thrust in infants and young children under sevoflurane anesthesia.
authors.affiliation: Department of Anesthesiology, Tianjin Children's Hospital, Clinical Pediatric College of Tianjin Medical University, Tianjin 300134, China.
authors.forename: J Z
authors.initials: JZ
authors.lastname: Liu
authors.forename: J
authors.initials: J
authors.lastname: Zhao
authors.forename: Y J
authors.initials: YJ
authors.lastname: Zhang
mesh_terms: D000758:Anesthesia; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002675:Child, Preschool; D003371:Cough; D005133:Eye Movements / Q000187:drug effects*; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D007223:Infant; D017214:Laryngeal Masks; D008738:Methyl Ethers / Q000008:administration & dosage*; D000077149:Sevoflurane; D064171:Superficial Back Muscles
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane