Improvement of laryngoscopic view by hand-assisted elevation and caudad traction of the shoulder during tracheal intubation in pediatric patients

Jin Hee Ahn,Ji Seon Jeong,Yong Hun Son,Doyeon Kim,Bong Gyu Seong,Nam-Su Gil

doi:10.1038/s41598-018-37770-6

Jin Hee Ahn, Ji Seon Jeong + Show 4 more

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https://doi.org/10.1038/s41598-018-37770-6

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Abstract

Pediatric patients have large heads and relatively small bodies, making it difficult to perform intubation even in the sniffing position. Therefore, this study was planned on the assumption that hand-assisted elevation and caudad traction of the shoulder (HA-ECTS) would compensate for the laryngoscopic view. In this observational study, 45 pediatric patients aged 0–36 months with an ASA physical status of I-III and scheduled for elective surgery under general anesthesia were enrolled. HA-ECTS was defined as hand-assisted personalized traction in the upper and caudad directions with both hands under the lower cervical area. The POGO (percentage of glottis opening) score, MO (mouth opening), and LHS (laryngoscopic handling score) were compared before and after HA-ECTS. The median [range] POGO score was 30[10–50]% and 60[15–80]% before and after HA-ECTS, respectively (median difference, 20; 95% confidence interval [CI] 10 to 25%; P = 0.002). MO was 1.0[0.8–1.9] cm and 1.8[1.3–2.0] cm before and after HA-ECTS, respectively (median difference, 0.45 cm; 95% CI 0.25 to 0.60; P < 0.001). The ease of laryngoscopic handling was improved after HA-ECTS(P < 0.001). The application of HA-ECTS to pediatric patients younger than 3 years improved POGO score, MO, and LHS and could prove to be an assistive technique for tracheal intubation.

Highlights

In pediatric patients in the supine position, reduction of airway tone during general anesthesia leads to retraction of the tongue to the posterior pharyngeal wall, resulting in collapse of the upper airway and limitation in advancement of the endotracheal tube and laryngoscopic view[1,2]
The median [range] percentage of glottis opening (POGO) score was 30 [10–50]% and 60 [15–80]% before and after HA-ECTS, respectively (Fig. 3A)
The median mouth opening (MO) was 1.0 [0.8–1.9] cm and 1.8 [1.3–2.0] cm before and after HA-ECTS, respectively (Fig. 3B)

Summary

Introduction

In pediatric patients in the supine position, reduction of airway tone during general anesthesia leads to retraction of the tongue to the posterior pharyngeal wall, resulting in collapse of the upper airway and limitation in advancement of the endotracheal tube and laryngoscopic view[1,2]. Improvement of the laryngoscopic view and position is important when performing tracheal intubation in pediatric patients. For pediatric patients under 2 years of age, head extension without elevation and with or without shoulder elevation results in proper intubating conditions[6,7,8,9]. The direct laryngoscopic view is not improved in every pediatric patient in the SP, and it is necessary to improve actual visualization by considering the relationship with oropharyngeal structures as well as ideal anatomic axes. We performed hand-assisted elevation and caudad traction of the shoulder (HA-ECTS) so that laryngeal exposure would be improved due to increase of space in oropharyngeal cavity and improvement in laryngeal axes and line of vision in tracheal intubation in pediatric patients. The aim of our study was to confirm the improvement degree of the laryngoscopic view after HA-ECTS in pediatric patients under 36 months of age

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