Airway Remodeling, Morphology, Patency, Position, Radiography in Otolaryngology
Conditions
Brief summary
The severity and frequency of respiratory events is increased in the supine body posture compared with the lateral position in emergency, difficult airway patients. The mechanism responsible is not clear but may relate to the effect of position on upper airway shape and size. 3D finite element model of upper airway filling based on MRI image reconstruction can effectively reflect the anatomy of the upper airway. This study compared the effect of body position on upper airway shape and size in individuals with lateral position among sedated subjects.
Detailed description
Anesthesiologists may encounter situations in which a accidental loss of airway patency occurs in patients in a lateral patient position during surgery. Intubation is required in the lateral position in cases of oropharyngeal bleeding to reduce the risk of aspiration, or in airway management in some patients with limited posture. The severity and frequency of respiratory events is increased in the supine body posture compared with the lateral position in emergency, difficult airway patients. The mechanism responsible is not clear but may relate to the effect of position on upper airway shape and size secondary to gravitational effects. Lateral positioning decreases upper airway obstruction in sleeping individuals, children breathing spontaneously, and adults during general anesthesia. The mechanical upper airway properties may become the dominant factor governing upper airway collapsibility during sedation due to the significant depression of consciousness and the impairment of neural mechanisms controlling compensatory neuromuscular responses. Anesthesiologists and surgeons who are responsible for airway management during procedures under sedation and the perioperative period should be well versed with the physiological and pathophysiological mechanisms affecting upper airway patency. 3D finite element model of upper airway filling based on MRI image reconstruction can effectively reflect the anatomy of the upper airway. The primary aim of this study was to determine the changes in upper airway shape and size that occur when sedated, spontaneously breathing adults are placed in the lateral position. These findings may provide new guidance for the evaluation and prediction of difficult airway during clinical anesthesia.
Interventions
BEHAVIORALMRI scanning first at supine position and then turn into lateral position
Magnetic resonance imaging was used to scan the upper airway of sedated subjects, first at supine position and then turn into lateral position.
Sponsors
Zhejiang Provincial Tongde Hospital
First Affiliated Hospital of Zhejiang University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
1. Subjects aged over than 18 years and less than 100 years 2. The American Society of Anesthesiologists (ASA) score was grade I to II 3. There was no serious cardiopulmonary disease
Exclusion criteria
1. Unable to maintain oxygenation before or during the examination and requiring intervention 2. Those with preoperative arrhythmia requiring intervention 3. Thosewith severe hematological diseases, severe metabolic diseases, severe liver and kidney organ insufficiency 4. Those do not consent to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pharyngeal volume | through study completion, an average of 2 months | pharyngeal volume |
| minimum cross-sectional area (MCSA) | through study completion, an average of 2 months | minimum cross-sectional area (MCSA) of upper airway-related sagittal, cross-sectional, and coronal planes |
| minimum anteroposterior | through study completion, an average of 2 months | minimum anteroposterior diameters |
| lateral diameters | through study completion, an average of 2 months | lateral diameters |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| three-dimensional geometrical modeling of the upper airway | through study completion, an average of 2 months | three-dimensional geometrical modeling of the upper airway by MATALAB software |
| Change of heart rates (HR) in beats per minute | before examination, immediately after examination at supine position, immediately before examination at lateral position, immediately after examination at lateral position | compared the change of HR in beats per minute between different position |
| Change of oxygenation (SpO2, %) | before examination, immediately after examination at supine position, immediately before examination at lateral position, immediately after examination at lateral position | compared the change of SpO2 (%) |
| Change of respiratory rates (RR) in respirations per minute | before examination, immediately after examination at supine position, immediately before examination at lateral position, immediately after examination at lateral position | compared the change of RR in respirations per minute between different position |
Countries
China
Outcome results
None listed