Abstract
BackgroundThe classic formula has been used to estimate the depth of tracheal tube intubation in children for decades. However, it is unclear whether this formula is applicable when the head and neck position changes intraoperatively.MethodsWe prospectively reviewed the data of 172 well-developed children aged 2–12 years (64.0% boys) who underwent head and neck surgery under general anesthesia. The distances from the tracheal carina to the endotracheal tube tip (CT), from the superior margin of the endotracheal tube tip to the vocal cord posterior commissure (CV), and from the tracheal carina to the posterior vocal commissure (TV) were measured in the sniffing position (maximum), neutral head, and maximal head flexion positions.ResultsAverage CT and CV in the neutral head position were 4.33 cm and 10.4 cm, respectively. They increased to 5.43 cm and 11.3 cm, respectively, in the sniffing position, and to 3.39 cm and 9.59 cm, respectively, in the maximal flexion position (all P-values < 0.001). TV remained unchanged and was only dependent on age. After stratifying patients by age, similar results were observed with other distances. CT and CV increased by 1.099 cm and 0.909 cm, respectively, when head position changed from neutral head to sniffing position, and decreased by 0.947 cm and 0.838 cm, respectively, when head position changed from neutral head to maximal flexion.ConclusionChange in head position can influence the depth of tracheal tube intubation. Therefore, the estimated depth should be corrected according to the surgical head position.
Highlights
The classic formula has been used to estimate the depth of tracheal tube intubation in children for decades
Under maximal head flexion position, CT and CV significantly shortened to 3.39 cm ± 1.35 cm and 9.59 cm ± 1.47 cm, respectively, whereas the posterior vocal commissure (TV) increased slightly to 6.20 cm ± 1.26 cm (P = 0.048) (Table 2)
When head position was changed from neutral head to sniffing position, both CT and CV increased by 1.099 cm and 0.909 cm, respectively
Summary
The classic formula has been used to estimate the depth of tracheal tube intubation in children for decades It is unclear whether this formula is applicable when the head and neck position changes intraoperatively. There are several simple formulas to calculate the depth of orotracheal intubation in children over 1 year of age, which are mainly based on body weight, body length, and age. All these formulas have been widely used in clinical practice for many decades. We conducted a prospective study on 172 Chinese children to quantify the impacts of intraoperative headneck position changes on the depth of oral tracheal tube intubation and attempted to create an appropriate formula for those surgical situations. All included children were in the top 3 percentile of growth
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