Head-position angles in children for opening the upper airway

Abstract

Aims Inexperienced health-care-providers may encounter severe problems to ventilate an unconscious child. Designing a ventilating device that could indicate how to open an upper airway correctly may be beneficial. Neutral position in young children and slight head extension in older children is recommended, although the optimal head angle is not clear. Thus, we compared effects of neutral head position and extension, measuring head-position angles and ventilation parameters. Methods Sixty-one children scheduled for tonsillectomy were enrolled, and were ventilated with pressure-controlled ventilation after anaesthesia induction. Results Children were divided into two groups: 1–5 years old (pre-school children, n = 38) and 6–10 years old (school children, n = 23). In neutral (mean ± SD: 1.3 ± 6.0) vs. head-extension position (13.2 ± 6.0; P < 0.001) in pre-school children, tidal volumes (132 ± 44,137 ± 49 ml), peak-expiratory flow (300 ± 90 vs. 310 ± 100 ml s −1) and expiratory airway resistance (20 ± 8 vs. 18 ± 6 cmH 2O s l −1) were comparable ( P = NS). In neutral (−0.4 ± 5.4) vs. head-extension position (15.7 ± 6.4; P < 0.001) in school children, expiratory airway resistance (17 ± 7 vs. 13 ± 5 cmH 2O s l −1; P = 0.048) differed, while tidal volume (224 ± 93 vs. 230 ± 92 ml) and peak-expiratory flow (427 ± 181 vs. 381 ± 144 ml s −1) were comparable ( P = NS). Conclusions Head-extension and neutral head-position angles differed in pre-school and school children. In pre-school children, neutral head position or head extension with an angle of −1° or 13°, and in school children head extension of 16°, may be used to achieve optimal ventilation of an unprotected airway.