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Article: Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: A new concept with possible clinical applications

TitleChanges in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: A new concept with possible clinical applications
Authors
Keywordsanaesthetic techniques, laryngoscopy
equipment, airway
intubation, tracheal, position
Issue Date2010
PublisherOxford University Press. The Journal's web site is located at http://bja.oxfordjournals.org/
Citation
British Journal Of Anaesthesia, 2010, v. 105 n. 5, p. 683-690 How to Cite?
AbstractBackground. The sniffing position is often considered optimal for direct laryngoscopy. Another concept of airway configuration involving a laryngeal vestibule axis and two curves has also been suggested. We investigated whether this theory can be supported mathematically and if it supports the sniffing position as being optimal for direct laryngoscopy.MethodsMagnetic resonance imaging scans were performed in 42 normal adult volunteers. The airway passage was divided into two curves - primary (oro-pharyngeal curve) and secondary (pharyngo-glotto-tracheal curve). Airway configuration was evaluated in the neutral, extension, head lift, and sniffing positions. The airway passage, point of inflection (where the two curves meet), its tangent, and the line of sight were plotted on each scan. The point of inflection lay within the laryngeal vestibule in all positions. The head lift and sniffing positions caused the tangent to the point of inflection to approximate the horizontal plane. The sniffing, extension, and head lift positions caused a reduction in the area between the line of sight and the airway curve compared with the neutral position.ConclusionsA two-curve theory is proposed as a basis for explaining airway configuration. The changes in these curves with head and neck positioning support the sniffing position as optimal for direct laryngoscopy. Application of this new concept to other forms of laryngoscopy should be investigated. © 2010 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
DescriptionComment in Br J Anaesth. 2011 Jun;106(6):909-910; author reply 910-911.
Persistent Identifierhttp://hdl.handle.net/10722/142300
ISSN
2015 Impact Factor: 5.616
2015 SCImago Journal Rankings: 2.314
ISI Accession Number ID
Funding AgencyGrant Number
Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital
Australian and New Zealand College of Anaesthetists
Funding Information:

Funding for this project was provided by the following organizations: (i) Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital; and (ii) Australian and New Zealand College of Anaesthetists.

References

 

DC FieldValueLanguage
dc.contributor.authorGreenland, KBen_HK
dc.contributor.authorEdwards, MJen_HK
dc.contributor.authorHutton, NJen_HK
dc.contributor.authorChallis, VJen_HK
dc.contributor.authorIrwin, MGen_HK
dc.contributor.authorSleigh, JWen_HK
dc.date.accessioned2011-10-28T02:42:24Z-
dc.date.available2011-10-28T02:42:24Z-
dc.date.issued2010en_HK
dc.identifier.citationBritish Journal Of Anaesthesia, 2010, v. 105 n. 5, p. 683-690en_HK
dc.identifier.issn0007-0912en_HK
dc.identifier.urihttp://hdl.handle.net/10722/142300-
dc.descriptionComment in Br J Anaesth. 2011 Jun;106(6):909-910; author reply 910-911.-
dc.description.abstractBackground. The sniffing position is often considered optimal for direct laryngoscopy. Another concept of airway configuration involving a laryngeal vestibule axis and two curves has also been suggested. We investigated whether this theory can be supported mathematically and if it supports the sniffing position as being optimal for direct laryngoscopy.MethodsMagnetic resonance imaging scans were performed in 42 normal adult volunteers. The airway passage was divided into two curves - primary (oro-pharyngeal curve) and secondary (pharyngo-glotto-tracheal curve). Airway configuration was evaluated in the neutral, extension, head lift, and sniffing positions. The airway passage, point of inflection (where the two curves meet), its tangent, and the line of sight were plotted on each scan. The point of inflection lay within the laryngeal vestibule in all positions. The head lift and sniffing positions caused the tangent to the point of inflection to approximate the horizontal plane. The sniffing, extension, and head lift positions caused a reduction in the area between the line of sight and the airway curve compared with the neutral position.ConclusionsA two-curve theory is proposed as a basis for explaining airway configuration. The changes in these curves with head and neck positioning support the sniffing position as optimal for direct laryngoscopy. Application of this new concept to other forms of laryngoscopy should be investigated. © 2010 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.en_HK
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://bja.oxfordjournals.org/en_HK
dc.relation.ispartofBritish Journal of Anaesthesiaen_HK
dc.subjectanaesthetic techniques, laryngoscopyen_HK
dc.subjectequipment, airwayen_HK
dc.subjectintubation, tracheal, positionen_HK
dc.subject.meshIntubation, Intratracheal/methods-
dc.subject.meshLaryngoscopy - methods-
dc.subject.meshMagnetic Resonance Imaging - methods-
dc.subject.meshPatient Positioning-
dc.subject.meshRespiratory System - anatomy and histology-
dc.titleChanges in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: A new concept with possible clinical applicationsen_HK
dc.typeArticleen_HK
dc.identifier.emailIrwin, MG:mgirwin@hku.hken_HK
dc.identifier.authorityIrwin, MG=rp00390en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1093/bja/aeq239en_HK
dc.identifier.pmid20846964-
dc.identifier.scopuseid_2-s2.0-77958183534en_HK
dc.identifier.hkuros184507en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77958183534&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume105en_HK
dc.identifier.issue5en_HK
dc.identifier.spage683en_HK
dc.identifier.epage690en_HK
dc.identifier.eissn1471-6771-
dc.identifier.isiWOS:000283119200019-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.citeulike8378805-

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