LATERAL POSITION IN CHILDREN DURING HEAD MRI UNDER GENERAL ANESTHESIA FOR PREVENTION OF UPPER AIRWAY COMPLICATIONS

Abstract

Background : Magnetic resonance imaging is essential investigation method for central nervous system lesions. Closed space and loud noise inside magnetic resonance machine can cause sense of fear in children, so it is common practice to use sedation or general anesthesia in children undergoing magnetic resonance imaging. For safe general anesthesia management endotracheal intubation or laryngeal mask airway placement are recommended. However not all magnetic resonance imaging offices are supplied with compatible equipment and often general anesthesia is provided on spontaneous breathing through natural airways. In emergency medicine lateral position can prevent upper airway complications such as obstruction, aspiration, cough and laryngospasm. The aim of our study was to compare incidence of upper airway complications in children in supine and lateral position undergoing head magnetic resonance imaging under general anesthesia. Materials and methods : Forty-one children undergoing elective head magnetic resonance imaging under general anesthesia were randomized into 2 groups: “Supine” and “Lateral”. Children under general anesthesia were left breathing spontaneously in supine or right lateral decubitus position with slight head and neck extension. Vital signs monitoring included ECG, SpO2, blood pressure and sidestream capnography. Episodes of desaturation, obstruction, apnea, need for airway manipulations such as Guedel airway or laryngeal mask airway placement, suctioning and manual ventilation were registered. Results : Incidence of upper airway complications and need for airway manipulations were significantly lower in “Lateral” group. Number of patients with no complications was significantly higher in “Lateral” group. Mean number of any complication per one patient in “Lateral” and “Supine” groups was 0.1 and 2.4 respectively. Number needed to treat of lateral position for total absence of complications was 1.3 and risk reduction of having any complication was 75.8%. Conclusion : Lateral position is simple maneuver that allows to decrease number of upper airway complications, upper airway manipulations and to increase safety of children undergoing head magnetic resonance imaging under general anesthesia on spontaneous breathing through natural airways.