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Anesthesia & Analgesia, 1998

nexpected loss of airway patency is a potential anesthetic disaster. The patency of the upper air... more nexpected loss of airway patency is a potential anesthetic disaster. The patency of the upper airway, which includes the nose and mouth, is maintained by a number of muscles (e.g., pharyngeal muscles) that resist the airway-collapsing effect of a negative transmural pressure. The oropharynx is considered the only collapsible segment of upper airway (1). The nasal airway is the primary pathway for normal breathing (2). It begins at the nostrils, and the anatomy and physiology of alae nasi ensure adequate airflow through the nostrils. The alar cartilages provide the nostrils with adequate rigidity, while the "dilator alae nasi" muscles dilate the nostrils at inspiration, especially during deep breathing. Collapse of the alae during inspiration closes the nostrils and, if for some reason the mouth cannot be opened, alar collapse can cause complete airway obstruction. The nostrils have not been included as the site or cause of airway obstruction in prominent anesthesia text books. We report one such case, which offers documentation for the occurrence of "variable" extrathoracic airway obstruction at the nostrils. A variable obstruction markedly diminishes inspiratory flow but leaves the expiratory flow relatively unchanged (2). Case Report A lZyr-old ASA physical status I patient was scheduled for the release of .quadriceps contracture in the left thigh. During the preanesthetic evaluation, we observed that the patient had a broad nasal lobule and slightly narrow nostrils. There was no history indicative of airway obstruction or adenotonsillar hypertrophy-like mouth breathing, noisy breathing, snoring, sleep apnea, or nasal discharge. The patient was premeditated with diazepam 5 mg and metoclopramide 5 mg given orally 2 h before surgery. Because the proposed surgery was of short duration (15 mm),

Anesthesia & Analgesia, 1998

nexpected loss of airway patency is a potential anesthetic disaster. The patency of the upper air... more nexpected loss of airway patency is a potential anesthetic disaster. The patency of the upper airway, which includes the nose and mouth, is maintained by a number of muscles (e.g., pharyngeal muscles) that resist the airway-collapsing effect of a negative transmural pressure. The oropharynx is considered the only collapsible segment of upper airway (1). The nasal airway is the primary pathway for normal breathing (2). It begins at the nostrils, and the anatomy and physiology of alae nasi ensure adequate airflow through the nostrils. The alar cartilages provide the nostrils with adequate rigidity, while the "dilator alae nasi" muscles dilate the nostrils at inspiration, especially during deep breathing. Collapse of the alae during inspiration closes the nostrils and, if for some reason the mouth cannot be opened, alar collapse can cause complete airway obstruction. The nostrils have not been included as the site or cause of airway obstruction in prominent anesthesia text books. We report one such case, which offers documentation for the occurrence of "variable" extrathoracic airway obstruction at the nostrils. A variable obstruction markedly diminishes inspiratory flow but leaves the expiratory flow relatively unchanged (2). Case Report A lZyr-old ASA physical status I patient was scheduled for the release of .quadriceps contracture in the left thigh. During the preanesthetic evaluation, we observed that the patient had a broad nasal lobule and slightly narrow nostrils. There was no history indicative of airway obstruction or adenotonsillar hypertrophy-like mouth breathing, noisy breathing, snoring, sleep apnea, or nasal discharge. The patient was premeditated with diazepam 5 mg and metoclopramide 5 mg given orally 2 h before surgery. Because the proposed surgery was of short duration (15 mm),