Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children

Case summary This paper presents two cases of acute postoperative upper airway obstruction following ventral bulla osteotomy (VBO) in cats. The first cat underwent a unilateral left-sided VBO for a suspected inflammatory polyp. The second cat underwent a single-session bilateral VBO procedure for bilateral otitis media. In the first case, immediate re-intubation and a gradual lightening of the anaesthetic plane resolved the clinical signs; in the second case, the patient deteriorated and went into acute cardiorespiratory arrest and received cardiopulmonary resuscitation. Both patients recovered well and were discharged home 3 days after surgery. Both cases were reported to show no further clinical signs on postoperative follow-up 3 weeks and 4 months after surgery, respectively. Relevance and novel information Upper airway obstruction should be regarded as a potential complication of VBO in cats.

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Effects of miniscrew-assisted orthodontic treatment with premolar extractions on upper airway dimensions in adult patients with Class II high-angle malocclusion

American Journal of Orthodontics and Dentofacial Orthopedics ◽

10.1016/j.ajodo.2020.02.016 ◽

2021 ◽

Author(s):

Xiaoxin Shi ◽

Hui Chen ◽

Frank Lobbezoo ◽

Erwin Berkhout ◽

Jan de Lange ◽

...

Keyword(s):

Orthodontic Treatment ◽

Upper Airway ◽

Class Ii ◽

Adult Patients ◽

High Angle ◽

Airway Dimensions

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Allergic Rhinitis

Pediatrics in Review ◽

10.1542/pir.13.9.323 ◽

1992 ◽

Vol 13 (9) ◽

pp. 323-328

Author(s):

Frank S. Virant

Keyword(s):

Allergic Rhinitis ◽

Clinical Signs ◽

Upper Airway ◽

Allergic Patient ◽

The United States ◽

Specific Ige ◽

Interferon Γ ◽

Interleukin 4 ◽

Primary Defect ◽

Primary Focus

Epidemiology Allergic rhinitis affects as many as 8% to 10% of children in the United States. Many of these children suffer significant morbidity, leading to millions of lost school days annually. Morbidity is amplified when these children concurrently suffer from complications of allergic rhinitis, such as recurrent otitis media or chronic sinus disease. Typically, children who have allergic rhinitis have a family history of atopic disorders. Upper airway allergy may become manifest at any age, but the appearance of symptoms is most common during childhood or young adulthood. Clinical signs of rhinitis may be perennial, seasonal, or episodic, and the primary focus of complaints may relate to secondary problems, including ear, sinus, or lung disease. Pathophysiology In the allergic patient, disease is mediated by the production of antigenspecific IgE by the patient's B lymphocytes. Current research suggests that the primary defect may be the excessive production of interleukin 4 (IL-4) or a deficient level of gamma interferon (γ-INF) when a T-cell is presented with an antigen. This constellation of immunomodulators directs the B-cell to produce IgE rather than the IgG response of the non-allergic patient. Clinical disease occurs when an allergen reacts with antigen-specific IgE on the patient's nasal mast cells. When these factors combine, the mast cell is activated to release a variety of preformed and newly produced mediators, including histamine, leukotrienes, and prostaglandins (Fig 1).

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Effect of Lateral Positioning on Upper Airway Size and Morphology in Sedated Children

Anesthesiology ◽

10.1097/00000542-200509000-00009 ◽

2005 ◽

Vol 103 (3) ◽

pp. 484-488 ◽

Cited By ~ 51

Author(s):

Ronald S. Litman ◽

Nicole Wake ◽

Lai-Ming Lisa Chan ◽

Joseph M. McDonough ◽

Sanghun Sin ◽

...

Keyword(s):

Magnetic Resonance ◽

Supine Position ◽

Upper Airway ◽

Lateral Position ◽

Magnetic Resonance Images ◽

Magnetic Resonance Imaging Examination ◽

Vocal Cords ◽

Cross Sectional ◽

Spontaneously Breathing ◽

Lateral Positioning

Background Lateral positioning decreases upper airway obstruction in paralyzed, anesthetized adults and in individuals with sleep apnea during sleep. The authors hypothesized that lateral positioning increases upper airway cross-sectional area and total upper airway volume when compared with the supine position in sedated, spontaneously breathing children. Methods Children aged 2-12 yr requiring magnetic resonance imaging examination of the head or neck region using deep sedation with propofol were studied. Exclusion criteria included any type of anatomical or neurologic entity that could influence upper airway shape or size. T1 axial scans of the upper airway were obtained in the supine and lateral positions, with the head and neck axes maintained neutral. Using software based on fuzzy connectedness segmentation (3D-VIEWNIX; Medical Imaging Processing Group, University of Pennsylvania, Philadelphia, PA), the magnetic resonance images were processed and segmented to render a three-dimensional reconstruction of the upper airway. Total airway volumes and cross-sectional areas were computed between the nasal vomer and the vocal cords. Two-way paired t tests were used to compare airway sizes between supine and lateral positions. Results Sixteen of 17 children analyzed had increases in upper airway total volume. The total airway volume (mean +/- SD) was 6.0 +/- 2.9 ml in the supine position and 8.7 +/- 2.5 ml in the lateral position (P < 0.001). All noncartilaginous areas of the upper airway increased in area in the lateral compared with the supine position. The region between the tip of the epiglottis and vocal cords demonstrated the greatest relative percent change. Conclusions The upper airway of a sedated, spontaneously breathing child widens in the lateral position. The region between the tip of the epiglottis and the vocal cords demonstrates the greatest relative percent increase in size.

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Evaluation of the upper airway dimensions following Herbst appliance treatment in adolescents: A retrospective study

APOS Trends in Orthodontics ◽

10.25259/apos_83_2020 ◽

2020 ◽

Vol 10 ◽

pp. 153-163

Author(s):

Min Gu ◽

Yifan Lin ◽

Colman Patrick Joseph McGrath ◽

Urban Hägg ◽

Ricky Wing Kit Wong ◽

...

Keyword(s):

Retrospective Study ◽

Soft Palate ◽

Upper Airway ◽

Class Ii Malocclusion ◽

Growth Data ◽

Herbst Appliance ◽

Downward Movement ◽

Dimensional Changes ◽

Lateral Cephalograms ◽

Airway Dimensions

Objectives: This retrospective study investigated dimensional changes in the upper airway following Herbst appliance therapy in adolescents with Class II malocclusion and compared those changes with growth data. Materials and Methods: Lateral cephalograms from 44 Herbst-treated adolescents (23 boys, mean age = 13.3 ± 1.1 years, and 21 girls, mean age = 12.6 ± 1.1 years) were analyzed for the changes in the upper airway and craniofacial variables. Longitudinal cephalometric data of 34 untreated adolescents (15 boys, mean age = 12.6 ± 0.3 years, and 19 girls, mean age = 12.9 ± 0.4 years) were used as growth data for comparison. Results: Following treatment, significant changes were noted in most of the variables. Boys displayed greater downward movement of the hyoid bone than girls did (P = 0.021). Compared with the growth data, a greater increase in retroglossal oropharyngeal depth and hypopharyngeal depth was observed in boys and girls, respectively. Both displayed a decrease in the inclination of the soft palate and a smaller change in nasopharyngeal depth. Conclusion: Herbst appliance therapy enlarges the upper airway dimensions at two dissimilar sites in girls (oropharynx) and boys (hypopharynx). Boys display a greater increase in anterior and posterior facial heights than girls do, potentially accounting for the site dissimilarities. Moreover, a Herbst appliance improves the inclination of the soft palate and restricts the growth of the nasopharynx in both boys and girls.

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The influence of craniofacial morphology on the upper airway dimensions

The Angle Orthodontist ◽

10.2319/061014-418.1 ◽

2014 ◽

Vol 85 (5) ◽

pp. 874-880 ◽

Cited By ~ 15

Author(s):

Iveta Indriksone ◽

Gundega Jakobsone

Keyword(s):

Linear Regression Analysis ◽

Upper Airway ◽

Correlation Coefficients ◽

Craniofacial Morphology ◽

Multivariate Linear Regression Analysis ◽

Cross Sectional ◽

Old Patients ◽

Oropharyngeal Airway ◽

Semiautomatic Segmentation ◽

Airway Dimensions

ABSTRACT Objective: To evaluate the influence of craniofacial morphology on the upper airway dimensions in healthy adult subjects. Materials and Methods: The records of 276 healthy 17- to 27-year-old patients were extracted from the cone-beam computed tomography image database of the Institute of Stomatology, Riga Stradins University. Dolphin 11.7 software was used to evaluate craniofacial anatomy and semiautomatic segmentation of the upper airway. Measurements of oropharyngeal airway volume (OPV), minimal cross-sectional area (CSAmin), and nasopharyngeal airway volume (NPV) were obtained. The presence of adenoid tissues was recorded. Associations between variables were analyzed by Spearman's correlation coefficients, and multivariate linear regression analysis was used to identify factors that had a possible influence on upper airway dimensions. Results: The following factors were identified as influencing the variability of NPV (23%): SNA angle, gender, and presence of adenoids. Statistically significant, although weak, correlations were found between SNB angle and OPV (r = 0.144, P < .05) and CSAmin (r = 0.182, P < .01). Conclusion: The results suggest that craniofacial morphology alone does not have a significant influence on upper airway dimensions.

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Pulmonary airway area by the two-microphone acoustic reflection method

Journal of Applied Physiology ◽

10.1152/jappl.1994.76.5.2234 ◽

1994 ◽

Vol 76 (5) ◽

pp. 2234-2240 ◽

Cited By ~ 35

Author(s):

B. Louis ◽

G. M. Glass ◽

J. J. Fredberg

Keyword(s):

Upper Airway ◽

Nasal Airway ◽

Reflection Method ◽

Acoustic Reflection ◽

Reflection Data ◽

Pulmonary Airway ◽

Airway Dimensions

We noninvasively assessed airway dimensions from acoustic reflection data measured at the mouth. We recently described a two-transducer system for measurement of the nasal airway. Here we apply this approach to the measurement of the upper airway and trachea. We describe the theoretical implications of breathing on this kind of measurement and propose a new procedure that, unlike single- and dual-transducer systems used currently, does not require the use of He-O2 for inference of geometry of subglottic airways.

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Effects of almitrine on genioglossal and diaphragmatic electromyograms

Journal of Applied Physiology ◽

10.1152/jappl.1986.61.6.2122 ◽

1986 ◽

Vol 61 (6) ◽

pp. 2122-2128 ◽

Cited By ~ 2

Author(s):

D. E. Weese-Mayer ◽

R. T. Brouillette ◽

L. M. Klemka ◽

C. E. Hunt

Keyword(s):

Slow Wave Sleep ◽

Minute Ventilation ◽

Upper Airway ◽

Respiratory Drive ◽

Peripheral Chemoreceptor ◽

Obstructive Sleep ◽

Adult Cats ◽

Alpha Chloralose ◽

Spontaneously Breathing ◽

Dose Dependent

We previously demonstrated dose-dependent increases in both hypoglossal and phrenic electroneurograms after almitrine in anesthetized, paralyzed, and vagotomized cats. We have now investigated the effect of this peripheral chemoreceptor stimulant on diaphragmatic and genioglossal (GG, an upper airway-maintaining muscle) electromyograms in five unanesthetized, chronically instrumented, spontaneously breathing adult cats during slow-wave sleep. In 12 studies almitrine doses of 1.0–6.0 mg/kg increased inspired minute ventilation (VI), frequency (f), and tidal volume (VT) and decreased expiratory time (TE). However, almitrine doses as high as 6.0 mg/kg failed to augment phasic inspiratory GG activity. To determine why almitrine induced phasic inspiratory upper airway activity in anesthetized, vagotomized cats but not in sleeping cats, additional studies were performed. In four dose-response studies in three pentobarbital-anesthetized cats, almitrine, 1.0–6.0 mg/kg, did not produce phasic inspiratory GG activity. Almitrine did induce phasic inspiratory GG activity in two of three studies in three vagotomized, tracheostomized, alpha-chloralose-urethan-anesthetized cats. These results suggest that almitrine would not be useful in obstructive sleep apnea, yet because almitrine markedly increased VI, f, and VT and decreased TE in unanesthetized sleeping cats the drug may be effective in patients who lack normal central neural respiratory drive, such as the preterm infant.

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