scholarly journals Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study

2021 ◽  
Vol 10 (17) ◽  
pp. 3910
Author(s):  
Hye Jin Kim ◽  
Jaewon Jang ◽  
So Yeon Kim ◽  
Wyun Kon Park ◽  
Hyun Joo Kim
Keyword(s):  
Head And Neck ◽  
Prospective Observational Study ◽  
Intracuff Pressure ◽  
Neutral Position ◽  
Pilot Balloon ◽  
Flexion Extension ◽  
Nasotracheal Tube ◽  
Head Flexion ◽  
Median Change ◽  
Head And Neck Position

To prevent endotracheal tube-related barotrauma or leakage, the intracuff pressure should be adjusted to 20–30 cm H2O. However, changes in the nasotracheal tube intracuff pressure relative to neck posture are unclear. In this study, we investigated the effect of head and neck positioning on nasotracheal tube intracuff pressure. Fifty adult patients with nasotracheal tubes who were scheduled for surgery under general anesthesia were enrolled. Following intubation, intracuff pressure was measured by connecting the pilot balloon to a device that continuously monitors the intracuff pressure. Subsequently, the intracuff pressure was set to 24.48 cm H2O (=18 mmHg) for the neutral position. We recorded the intracuff pressures based on the patients’ position during head flexion, extension, and rotation. The initial intracuff pressure was 42.2 cm H2O [29.6–73.1] in the neutral position. After pressure adjustment in the neutral position, the intracuff pressure was significantly different from the neutral to flexed (p < 0.001), extended (p = 0.003), or rotated (p < 0.001) positions. Although the median change in intracuff pressure was <3 cm H2O when each patient’s position was changed, overinflation to >30 cm H2O occurred in 12% of patients. Therefore, it is necessary to adjust the intracuff pressure after tracheal intubation and each positional change.

scholarly journals Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sandeep Kumar Mishra ◽  
Mohammad Nawaz ◽  
M. V. S. Satyapraksh ◽  
Satyen Parida ◽  
Prasanna Udupi Bidkar ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neutral Position ◽  
Leak Pressure ◽  
Neck Position ◽  
Oropharyngeal Leak Pressure ◽  
Flexion Extension ◽  
Margin Of Safety ◽  
Effective Ventilation ◽  
End Tidal ◽  
Head And Neck Position

Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis) and ventilation scores between ProSeal LMA and the I-gel.Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left). The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2were noted in all positions.Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation), lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups.Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

scholarly journals Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Nobuyasu Komasawa ◽  
Ryosuke Mihara ◽  
Kentaro Imagawa ◽  
Kazuo Hattori ◽  
Toshiaki Minami
Keyword(s):  
Head And Neck ◽  
Cuff Pressure ◽  
High Volume ◽  
Low Pressure ◽  
Neutral Position ◽  
Neck Position ◽  
Flexion Extension ◽  
Pressure Changes ◽  
Flexion And Extension ◽  
Head And Neck Position

The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP) and taper-shaped (taper) cuffs in a prospective randomized clinical trial.Methods. Forty patients were intubated using tracheal tubes with either HVLP (n=20; HVLP group) or taper-shaped (n=20; Taper group) cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation.Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure.Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered withUMIN000016119.

The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population

2013 ◽  
Vol 24 (3) ◽  
pp. 316-321 ◽  
Author(s):  
Hiromi Kako ◽  
Senthil G. Krishna ◽  
Archana S. Ramesh ◽  
Meredith N. Merz ◽  
Charles Elmaraghy ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Head And Neck ◽  
Pediatric Population ◽  
Intracuff Pressure ◽  
Neck Position ◽  
The Relationship ◽  
Head And Neck Position

scholarly journals ¿Cambia realmente la localización de la membrana cricotiroidea medida en posición neutra con la extensión de la cabeza y cuello? La ecografía nos abre los ojos.

2020 ◽  
Vol 12 (2) ◽  
pp. 2
Author(s):  
Natalia Muñoz Ávalos ◽  
Jose Alberto Suarez Del Arco
Keyword(s):  
Head And Neck ◽  
Low Frequency ◽  
Neutral Position ◽  
Cricothyroid Membrane ◽  
Anesthetic Induction ◽  
Ideal Position ◽  
Successful Resolution ◽  
Membrane Location ◽  
Head And Neck Position ◽  
The Ideal

      El abordaje quirúrgico de urgencia de la vía aérea ante una situación “no intubable – no ventilable” es un escenario que implica, por parte del anestesiólogo, un adecuado entrenamiento que posibilite una resolución exitosa en el menor tiempo posible. Dada la poca frecuencia de esta práctica, muchos anestesiólogos optan por localizar la membrana cricotiroidea antes de realizar la inducción anestésica con la cabeza y cuello en posición neutra. Ante esto, y, considerando la posición ideal para una cricotiroidotomía al paciente con la cabeza y cuello en extensión, los autores de este artículo tratan de determinar si existe realmente cambio en la localización de dicha membrana con la variación de la cabeza y cuello de posición neutra a extendida así como si se modifica la altura de la misma. Para ello, realizan un estudio observacional con 22 voluntarios sanos a los que un radiólogo, con más de quince años de experiencia, mide con ecografía la distancia entre los bordes superior e inferior de la membrana y realiza una marca en el punto medio de la misma en las dos posiciones antes citadas. Los resultados obtenidos nos llevan a una importante reflexión que nos conduce a un cambio en el paradigma clásico de abordaje de la cricotiroidotomía. ABSTRACT Does the cricothyroid membrane location really change with the extension of the head and neck from neutral position? Ultrasound opens our eyes. The emergency surgical approach of the airway to a situation "can’t intubate, can’t oxygenate’ is a scenario implies an adequate training on the part of the anesthesiologist that enables a successful resolution in the shortest posible time. In view of the low frequency of this practice, many anesthesiologists choose to locate the cricothyroid membrane before performing the anesthetic induction with the head and neck in a neutral position. Considering this and that the ideal position for a cricothyroidotomy is placing the head and neck in extension, the authors of this article try to determine if there is a change in the location of the membrane with the variation of the head and neck position from neutral to extended as well as if the height of the membrane is modified. To do this, hey performed an observational study with 22 healthy volunteers to whom a radiologist with more than fifteen years of experience measures with ultrasound the distance between the upper and lower membrane edges and makes a mark at the midpoint of the same in the two positions mentioned above. The results obtained from the study lead us to an important reflection that leads us to a change in the classical paradigm of approach of the cricothyroidotomy.    

Biomechanics of the Cervical Spine Under Compressive Loading in Flexion and Extension: Muscles Net Moment Determination

2012 ◽  
Author(s):  
Wissal Mesfar ◽  
Kodjo Moglo
Keyword(s):  
Cervical Spine ◽  
Head And Neck ◽  
Compressive Loading ◽  
Compressive Load ◽  
Element Model ◽  
Neutral Position ◽  
Numerical Studies ◽  
Head Extension ◽  
Head Flexion ◽  
The Impact

Muscles in the cervical spine are responsible for guiding the head and for conserving its posture. The weight of the head (∼40N) exerts a continuous compressive load that should be monitored by the neck muscles. Wearing a helmet in many sports or military and work activities increases the compressive loading on the head as well as the involvement of the muscles to counterbalance the impact of this supplemental weight. The compressive load is estimated to range from 120 to 1200N [1]. This loading influences all the biomechanics of the head and neck complex and its musculature. Experimental and numerical studies were involved to determine the biomechanical response of the head and neck [2]. In this study and based on our finite element model, we aim to estimate the biomechanical impact of a compressive load varying from 0N to 100N on the head and neck complex at four positions, neutral position, 10 and 20 deg of head flexion and 10 deg of head extension. An evaluation of the required muscles net moment to conserve the head at each posture will also be done.

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