Effect of head posture on pediatric oropharyngeal... : Current Opinion in Anesthesiology (original) (raw)

Pediatric anesthesia: Edited by Bernard J. Dalens

Effect of head posture on pediatric oropharyngeal structures: implications for airway management in infants and children

aRéanimation Pédiatrique, Département d'Anesthésie-Réanimation Hôpital Nord, CHU Marseille, France

bService de Réanimation, Hôpital d'Instruction des Armées, Laveran, Marseille, France

Correspondence to Renaud Vialet, MD, Réanimation Pédiatrique, Département d'Anesthésie-Réanimation Hôpital Nord, CHU Marseille Chemin des Bourelly, 13 915 Marseille Cedex 20, France Tel: +04 91 96 86 68; fax: +04 91 86 26 18; e-mail: [email protected]

Abstract

Purpose of review

Although head and neck posture has direct effects on the upper airway in infants and children, many of these effects remain unclear or not well established. As airway patency and airway access are critical in sedated and/or unconscious children, recent developments in this area should be made known to pediatric anesthesiologists, intensive care physicians and other emergency caregivers.

Recent findings

All recent studies observed large interindividual variability in anatomical measurements, especially in trachea length. More evidence has been gained that lateral position improves upper airway patency in sedated children. Several studies brought indirect information on head posture for laryngoscopy and intubation.

Summary

The site of obstruction of the airway in sedated children in different postures is now more clear. Implications of head flexion and extension in intubated children have been extensively studied, and clinical consequences have been detailed. Due to large interindividual anatomic variability, depth marks set on the tubes by their manufacturers and guidelines regarding calculations of insertion depth should be made with caution in infants and neonates. Despite several studies, there is still little scientific evidence regarding proper head posture for laryngoscopy and intubation.