Airway Characteristics and Safe Management of Spontaneously Breathing Patients: Risks of Sedation and Analgesia and Changes in Wakefulness — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Airway Characteristics and Safe Management of Spontaneously Breathing Patients: Risks of Sedation and Analgesia and Changes in Wakefulness
Department of Anesthesia and Intensive Care Medicine, Hospital of Zollikerberg, Zollikerberg, Switzerland
1 Department of Anesthesia and Intensive Care Medicine, Hospital of Zollikerberg, Zollikerberg, Switzerland
The goal of safe airway management is to maintain a patent airway. Lack of knowledge of the anatomical morphology and changes that may occur in the upper airway during sedation and unconsciousness may lead to critical incidents and hazardous complications. This review focuses on the risks of sedation and analgesia and changes in wakefulness on airway patency in spontaneously breathing patients. Furthermore, key elements of airway management are presented and discussed.
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists (2002) Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology, 96, 1004-1017. http://dx.doi.org/10.1097/00000542-200204000-00031
Schwab, R.J., Gefter, W.B., Pack, A.I. and Hoffman, E.A. (1993) Dynamic Imaging of the Upper Airway during Respiration in Normal Subjects. Journal of Applied Physiology, 74, 1504-1514.
Schwab, R.J. (1996) Properties of Tissues Surrounding the Upper Airway. Sleep, 19, S170-S174.
Malhotra, A., Huang, Y., Fogel, R.B., Pillar, G., Edwards, J.K., Kikinis, R., Loring, S.H. and White, D.P. (2002) The Male Predisposition to Pharyngeal Collapse: Importance of Airway Length. American Journal of Respiratory and Critical Medicine, 166, 1388-1395. http://dx.doi.org/10.1164/rccm.2112072
Trudo, F.J., Gefter, W.B., Welch, K.C., Gupta, K.B., Maislin, G. and Schwab, R.J. (1998) State-Related Changes in Upper Airway Caliber and Surrounding Soft-Tissue Structures in Normal Subjects. American Journal of Respiratory and Critical Care Medicine, 158, 1259-1270. http://dx.doi.org/10.1164/ajrccm.158.4.9712063
Hillman, D.R., Platt, P.R. and Eastwood, P.R. (2010) Anesthesia, Sleep, and Upper Airway Collapsibility. Anesthesiology Clinics, 28, 443-455. http://dx.doi.org/10.1016/j.anclin.2010.07.003
Cravero, J.P., Beach, M.L., Blike, G.T., Gallagher, S.M., Hertzog, J.H. and Pediatric Sedation Research Consortium (2009) The Incidence and Nature of Adverse Events during Pediatric Sedation/Anesthesia with Propofol for Procedures Outside the Operating Room: A Report from the Pediatric Sedation Research Consortium. Anesthesia & Analgesia, 108, 795-804. http://dx.doi.org/10.1213/ane.0b013e31818fc334
Evans, R.G., Crawford, M.W., Noseworthy, M.D. and Yoo, S.J. (2003) Effect of Increasing Depth of Propofol Anesthesia on Upper Airway Configuration in Children. Anesthesiology, 99, 596-602. http://dx.doi.org/10.1097/00000542-200309000-00014
Mahmoud, M., Gunter, J., Donnelly, L.F., Wang, Y., Nick, T.G. and Sadhasivam, S. (2009) A Comparison of Dexmedetomidine with Propofol for Magnetic Resonance Imaging Sleep Studies in Children. Anesthesthesia & Analgesia, 109, 745-753. http://dx.doi.org/10.1213/ane.0b013e3181adc506
Dewachter, P., Mouton-Faivre, C., Castells, M.C. and Hepner, D.L. (2011) Anesthesia in the Patient with Multiple Drug Allergies: Are all Allergies the Same? Current Opinion in Anesthesiology, 24, 320-325. http://dx.doi.org/10.1097/ACO.0b013e3283466c13
Ehsan, Z., Mahmoud, M., Shott, S.R., Amin, R.S. and Ishman, S.L. (2016) The Effects of Anesthesia and Opioids on the Upper Airway: A Systematic Review. Laryngoscope, 126, 270-284. http://dx.doi.org/10.1002/lary.25399
Lu, J., Nelson, L.E., Franks, N., Maze, M., Chamberlin, N.L. and Saper, C.B. (2008) Role of Endogenous Sleep-Wake and Analgesic Systems in Anesthesia. The Journal of Comparative Neurology, 508, 648-662. http://dx.doi.org/10.1002/cne.21685
Green, S.M., Rothrock, S.G., Lynch, E.L., Ho, M., Harris, T., Hestdalen, R., Hopkins, G.A., Garrett, W. and Westcott, K. (1998) Intramuscular Ketamine for Pediatric Sedation in the Emergency Department: Safety Profile in 1022 Cases. Annals of Emergency Medicine, 31, 688-697. http://dx.doi.org/10.1016/S0196-0644(98)70226-4
Mosier, J.M., Joshi, R., Hypes, C., Pacheco, G., Valenzuela, T. and Sakles, J.C. (2015) The Physiologically Difficult Airway. Western Journal of Emergency Medicine, 16, 1109-1117. http://dx.doi.org/10.5811/westjem.2015.8.27467
Adams, L., Butas, S. and Spurlock Jr., D. (2015) Capnography (ETCO2), Respiratory Depression, and Nursing Interventions in Moderately Sedated Adults Undergoing Transesophageal Echocardiography (TEE). Journal of Perianesthesia Nursing, 30, 14-22. http://dx.doi.org/10.1016/j.jopan.2013.07.009
Isono, S., Tanaka, A. and Nishino, T. (2002) Lateral Position Decreases Collapsibility of the Passive Pharynx in Patients with Obstructive Sleep Apnea. Anesthesiology, 97, 780-785. http://dx.doi.org/10.1097/00000542-200210000-00006
Litman, R.S., Wake, N., Chan, L.M., McDonough, J.M., Sin, S., Mahboubi, S. and Arens, R. (2005) Effect of Lateral Positioning on Upper Airway Size and Morphology in Sedated Children. Anesthesiology. 103, 484-488. http://dx.doi.org/10.1097/00000542-200509000-00009
Collins, J.S., Lemmens, H.J., Brodsky, J.B., Brock-Utne, J.G. and Levitan, R.M. (2004) Laryngoscopy and Morbid Obesity: A Comparison of the “Sniff” and “Ramped” Positions. Obesity Surgery, 14, 1171-1175. http://dx.doi.org/10.1381/0960892042386869
Lewanda, A.F., Matisoff, A., Revenis, M., Harahsheh, A., Futterman, C., Nino, G., Greenberg. J., Myseros, J.S., Rosenbaum, K.N. and Summar, M. (2016) Preoperative Evaluation and Comprehensive Risk Assessment for Children with Down Syndrome. Paediatric Anaesthesia, 26, 356-362. http://dx.doi.org/10.1111/pan.12841
Shorten, G.D., Armstrong, D.C., Roy, W.I. and Brown, L. (1995) Assessment of the Effect of Head and Neck Position on Upper Airway Anatomy in Sedated Paediatric Patients Using Magnetic Resonance Imaging. Pediatric Anesthesia, 5, 243-248. http://dx.doi.org/10.1111/j.1460-9592.1995.tb00292.x
Vialet, R., Nau, A., Chaumoître, K. and Martin, C. (2008) Effects of Head Posture on the Oral, Pharyngeal and Laryngeal Axis Alignment in Infants and Young Children by Magnetic Resonance Imaging. Paediatric Anaesthesia, 18, 525-531. http://dx.doi.org/10.1111/j.1460-9592.2008.02530.x
Moustafa, M.A., Emara, D.M. and Nouh, M.R. (2015) Effect of a Neck Collar on Upper Airway Size in Children Sedated with Propofol-Midazolam Combination during Magnetic Resonance Imaging. Paediatric Anaesthesia, 25, 421-427. http://dx.doi.org/10.1111/pan.12593
Isono, S., Tanaka, A., Sho, Y., Konno, A. and Nishino, T. (1995) Advancement of the Mandible Improves Velopharyngeal Airway Patency. Journal of Applied Physiology, 79, 2132-2138.
Paal, P., Niederklapfer, T., Keller, C., von Goedecke, A., Luckner, G., Pehboeck, D., Mitterlechner, T., Herff, H., Riccabona, U. and Wenzel, V. (2010) Head-Position Angles in Children for Opening the Upper Airway. Resuscitation, 81, 676-678. http://dx.doi.org/10.1016/j.resuscitation.2010.01.022
Ishikawa, T., Isono, S., Aiba, J., Tanaka, A. and Nishino, T. (2002) Prone Position Increases Collapsibility of the Passive Pharynx in Infants and Small Children. American Journal of Respiratory and Critical Care Medicine, 166, 760-764. http://dx.doi.org/10.1164/rccm.200110-044OC
Safiruddin, F., Koutsourelakis, I. and de Vries, N. (2015) Upper Airway Collapse during Drug Induced Sleep Endoscopy: Head Rotation in Supine Position compared with Lateral Head and Trunk Position. European Archives of Oto-Rhino-Laryngology, 272, 485-488. http://dx.doi.org/10.1007/s00405-014-3215-z
Reber, A., Paganoni, R. and Frei, F.J. (2001) Effect of Common Airway Manoeuvres on Upper Airway Dimensions and Clinical Signs in Anaesthetized, Spontaneously Breathing Children. British Journal of Anaesthesia, 86, 217-222. http://dx.doi.org/10.1093/bja/86.2.217
Reber, A., Bobbià, S.A., Hammer, J. and Frei F.J. (2001) Effect of Airway Opening Manoeuvres on Thoraco-Abdominal Asynchrony in Anaesthetized Children. European Respiratory Journal, 17, 1239-1243. http://dx.doi.org/10.1183/09031936.01.00047801
Shelton, K.E., Woodson, H., Gay, S. and Suratt, P.M. (1993) Pharyngeal Fat in Obstructive Sleep Apnea. American Revue of Respiratory Disease, 148, 462-466. http://dx.doi.org/10.1164/ajrccm/148.2.462
Roth, B., Magnusson, J., Johansson. I., Holmberg, S. and Westrin, P. (1998) Jaw Lift—A Simple and Effective Method to Open the Airway in Children. Resuscitation, 39, 171-174. http://dx.doi.org/10.1016/S0300-9572(98)00132-4
Von Ungern-Sternberg, B.S., Erb, T.O. and Frei, F.J. (2005) Jaw Thrust Can Deteriorate Upper Airway Patency. Acta Anaesthesiologica Scandinavica, 49, 583-585. http://dx.doi.org/10.1111/j.1399-6576.2005.00637.x
Atkins, D.L., Berger, S., Duff, J.P., Gonzales, J.C., Hunt, E.A., Joyner, B.L., Meaney, P.A., Niles, D.E., Samson, R.A. and Schexnayder, S.M. (2015) Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132, S519-S525. http://dx.doi.org/10.1161/cir.0000000000000265
Von Ungern-Sternberg, B.S., Erb, T.O., Reber, A. and Frei F.J. (2005) Opening the Upper Airway-Airway Maneuvers in Pediatric Anesthesia. Paediatric Anaesthesia, 15, 181-189. http://dx.doi.org/10.1111/j.1460-9592.2004.01534.x
Prasarn, M.L., Horodyski, M., Scott, N.E., Konopka, G., Conrad, B. and Rechtine, G,R. (2014) Motion Generated in the Unstable Upper Cervical Spine during Head Tilt-Chin Lift and Jaw Thrust Maneuvers. The Spine Journal, 14, 609-614. http://dx.doi.org/10.1016/j.spinee.2013.06.080
Oto, J., Li, Q., Kimball, W.R., Wang, J., Sabouri, A.S., Harrell, P.G., Kacmarek, R.M. and Jiang, Y. (2013) Continuous Positive Airway Pressure and Ventilation Are More Effective with a Nasal Mask than a Full Face Mask in Unconscious Subjects: A Randomized Controlled Trial. Critical Care, 17, R300. http://dx.doi.org/10.1186/cc13169
Bruppacher, H., Reber, A., Keller, J.P., Geiduschek, J., Erb, T.O. and Frei, F.J. (2003) The Effects of Common Airway Maneuvers on Airway Pressure and Flow in Children undergoing Adenoidectomies. Anesthesia & Analgesia, 97, 29-34. http://dx.doi.org/10.1213/01.ANE.0000069508.69518.97
Perilli, V., Sollazzi, L., Bozza, P., Modesti, C., Chierichini, A., Tacchino, R.M. and Ranieri, R. (2000) The Effects of the Reverse Trendelenburg Position on Respiratory Mechanics and Blood Gases in Morbidly Obese Patients during Bariatric Surgery. Anesthesia & Analgesia, 91, 1520-1525. http://dx.doi.org/10.1097/00000539-200012000-00041
Genta, P.R., Schorr, F., Eckert, D.J., Gebrim, E., Kayamori, F., Moriya, H.T., Malhotra, A. and Lorenzi-Filho, G. (2014) Upper Airway Collapsibility Is Associated with Obesity and Hyoid Position. Sleep, 37, 1673-1678. http://dx.doi.org/10.5665/sleep.4078
Ciscar, M.A., Juan, G., Martínez, V., Ramón, M., Lloret, T., Mínguez, J., Armengot, M., Marín, J. and Basterra, J. (2001) Magnetic Resonance Imaging of the Pharynx in OSA Patients and Healthy Subjects. European Respiratory Journal, 17, 79-86. http://dx.doi.org/10.1183/09031936.01.17100790
Pien, G.W., Keenan, B.T., Marcus, C.L., Staley, B., Ratcliffe, S.J., Jackson, N.J., Wieland, W., Sun, Y. and Schwab, R.J. (2016) An Examination of Methodological Paradigms for Calculating Upper Airway Critical Pressures during Sleep. Sleep, 39, 977-987. http://dx.doi.org/10.5665/sleep.5736
Shin, C.H., Zaremba, S., Devine, S., Nikolov, M., Kurth, T. and Eikermann, M. (2016) Effects of Obstructive Sleep Apnoea Risk on Postoperative Respiratory Complications: Protocol for a Hospital-Based Registry Study. BMJ Open, 6, e008436. http://dx.doi.org/10.1136/bmjopen-2015-008436
McNicholas, W.T., Bonsignore, M.R., Lévy, P. and Ryan, S. (2016) Mild Obstructive Sleep Apnoea: Clinical Relevance and Approaches to Management. The Lancet Respiratory Medicine, 4, 826-834. http://dx.doi.org/10.1016/S2213-2600(16)30146-1
Sanders, M.H., Kern, N.B., Stiller, R.A., Strollo Jr., P.J., Martin, T.J. and Atwood Jr., C.W. (1994) CPAP Therapy via Oronasal Mask for Obstructive Sleep Apnea. Chest, 106, 774-779. http://dx.doi.org/10.1378/chest.106.3.774