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Effect of Head Elevation on Passive Upper Airway Collapsibility in Normal Subjects during Propofol Anesthesia.

机译:Head Expation对丙多酚麻醉期间正常受试者被动上气道可折叠的影响。

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BACKGROUND: : Head elevation can restore airway patency during anesthesia, although its effect may be offset by concomitant bite opening or accidental neck flexion. The aim of this study is to examine the effect of head elevation on the passive upper airway collapsibility during propofol anesthesia. METHOD: : Twenty male subjects were studied, randomized to one of two experimental groups: fixed-jaw or free-jaw. Propofol infusion was used for induction and to maintain blood at a constant target concentration between 1.5 and 2.0 mug/ml. Nasal mask pressure (PN) was intermittently reduced to evaluate the upper airway collapsibility (passive PCRIT) and upstream resistance (RUS) at each level of head elevation (0, 3, 6, and 9 cm). The authors measured the Frankfort plane (head flexion) and the mandible plane (jaw opening) angles at each level of head elevation. Analysis of variance was used to determine the effect of head elevation on PCRIT, head flexion, and jaw opening within each group. RESULTS: : In both groups the Frankfort plane and mandible plane angles increased with head elevation (P < 0.05), although the mandible plane angle was smaller in the free-jaw group (i.e., increased jaw opening). In the fixed-jaw group, head elevation decreased upper airway collapsibility (PCRIT approximately -7 cm H2O at greater than 6 cm elevation) compared with the baseline position (PCRIT approximately -3 cm H2O at 0 cm elevation; P < 0.05). CONCLUSION: : Elevating the head position by 6 cm while ensuring mouth closure (centric occlusion) produces substantial decreases in upper airway collapsibility and maintains upper airway patency during anesthesia.
机译:背景:头部高程可以在麻醉时恢复气道通畅,尽管其效果可能被伴随的咬合开口或意外颈部屈曲抵消。本研究的目的是检查头部高度对异丙酚麻醉期间的被动上气道可折叠的影响。方法:研究了20个男性受试者,随机转移到两种实验组中的一种:固定下颌或自由下颌。异丙酚输注用于诱导,并在1.5-2.0麦克风/ mL之间的恒定靶浓度下保持血液。间歇地还原鼻掩模压力(PN)以评估每个头部凸起(0,3,6和9cm)的上部气道可折叠(无源PCRIT)和上游电阻(RUS)。作者测量了法兰克福平面(头部屈曲)和颌下平面(颌骨开口)角度,在每个头部仰角处。方差分析用于确定每个组内头升高对PCRIT,头部屈曲和颌骨开口的影响。结果:在两个组中,法兰克福平面和下颌骨平面角度随头部高度而增加(P <0.05),尽管在自由钳口组(即,增加的钳口开口)中下颌骨平面角度较小。在固定钳口组中,与基线位置相比结论::将头部位置升高6厘米,同时确保口腔闭合(以中心闭塞)产生大量降低的上气道可折叠,在麻醉时保持上气道通畅。

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