The effects of common airway maneuvers on airway pressure and flow in children undergoing adenoidectomies

Obstruction of the upper airway occurs frequently in anesthetized, spontaneously breathing children, especially in those with adenoidal hyperplasia. To improve airway patency, maneuvers such as chin lift (CL), jaw thrust (IT), and continuous positive airway pressure (CPAP) are often used. In this study, we examined the comparative efficacy of these maneuvers in children scheduled to undergo adenoidectomy. Sixteen children aged 2-9 yr were anesthetized with sevoflurane. During spontaneous breathing, the flows and pressures in the mask (ma), oropharynx (op), and esophagus (es) were measured simultaneously, and maximal pressure differences during inspiration (DeltaP) were calculated. After baseline recording, CL and JT maneuvers were performed in random order without and with CPAP (5 cm. H2O). The observed DeltaP(ma) - P-es of 12.3 +/- 3.4 cm H2O at baseline decreased with all airway maneuvers (P < 0.05). This resulted from decreases of DeltaP(ma) - P-op (P < 0.05) and DeltaP(op) - P-es (P < 0.05) in all interventions except CL, in which DeltaP(ma) - P-op remained similar. In contrast, significant improvements of minute ventilation and maximal inspiratory peak flow (P > 0.05) were observed only with JT (with and without CPAP). We conclude that CL may improve airway patency and ventilation, whereas JT with or without CPAP was the most effective maneuver to overcome airway obstruction in children with adenoidal hyperplasia.