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A two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position for immobilization of the cervical spine

Abstract

Purpose

Immobilization of the cervical spine after trauma is recommended as standard care to prevent secondary injury. We tested the hypothesis that a two-handed airway maneuver, consisting of mandibular advancement and mouth opening in the neutral neck position, would minimize changes in the angle of the cervical vertebrae at the C0/4 level and tidal volume in non-obese patients under anesthesia with neuromuscular blockade.

Methods

Twenty consecutive patients without cervical spine injury undergoing general anesthesia were enrolled and evaluated. The primary variable was change in the angle of the cervical vertebrae at the C0/4 level during mask ventilation using the modified two-handed technique. Secondary variables included changes in the angles of the cervical vertebrae at each level between C0 and C4, anterior movement of the vertebral bodies, change in the angle between the head and neck, change in the pharyngeal airway space, and tidal volume during mask ventilation.

Results

The two-handed airway maneuver of mandibular advancement and mouth opening resulted in statistically significant changes in the angle of the cervical spine at the C0/4 level (3.2 ± 3.0 degrees, P < 0.001) and the C3/4 level (1.4 ± 2.2 degrees, P = 0.01). The two-handed airway maneuver provided adequate mask ventilation without anterior movement of the vertebral bodies.

Conclusion

Our study suggests that a two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position results in only slight change in the cervical vertebral angle at the C0/4 level in non-obese patients under general anesthesia with neuromuscular blockade.

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References

  1. 1.

    Crosby ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104:1293–318.

    Article  Google Scholar 

  2. 2.

    Joffe AM, Hetzel S, Liew EC. A two-handed jaw-thrust technique is superior to the one-handed “EC-clamp” technique for mask ventilation in the apneic unconsciousness person. Anesthesiology. 2010;113:873–9.

    Article  Google Scholar 

  3. 3.

    Isono S. One hand, two hands, or no hands for maximizing airway maneuvers? Anesthesiology. 2008;109:576–7.

    Article  Google Scholar 

  4. 4.

    Isono S, Tanaka A, Tagaito Y, Ishikawa T, Nishino T. Influences of head positions and bite opening on collapsibility of the passive pharynx. J Appl Physiol. 2004;97:339–46.

    Article  Google Scholar 

  5. 5.

    Hirabayashi Y, Fujita A, Seo N, Sugimoto H. Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh laryngoscope. Anaesthesia. 2007;62:1050–5.

    CAS  Article  Google Scholar 

  6. 6.

    Hirabayashi Y, Fujita A, Seo N, Sugimoto H. A comparison of cervical spine movement during laryngoscopy using the Airtraq or Macintosh laryngoscopes. Anaesthesia. 2008;63:635–40.

    CAS  Article  Google Scholar 

  7. 7.

    Hirabayashi Y, Fujita A, Seo N, Sugimoto H. Distortion of anterior airway anatomy during laryngoscopy with the GlideScope videolaryngoscope. J Anesth. 2010;24:366–72.

    Article  Google Scholar 

  8. 8.

    Oh H, Kim H, Yoon HK, Lee HC, Park HP. No radiographic index predicts difficult intubation using the Optiscope in cervical spine surgery patients: a retrospective study. BMC Anesthesiol. 2020. https://doi.org/10.1186/s12871-020-00966-3.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Tseng YC, Hsiao SY, Cheng JH, Hsu KJ, Chen CM. Postoperative skeletal stability and pharyngeal airway: counterclockwise versus clockwise rotation during mandibular setback surgery. Biomed Res Int. 2020. https://doi.org/10.1155/2020/3283080.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Hirabayashi Y, Fujita A, Sugimoto H. Cervical spine movement during bag-mask ventilation. Masui. 2013;62:337–40.

    PubMed  Google Scholar 

  11. 11.

    Okuyama M, Kato S, Sato S, Okazaki J, Kitamura Y, Ishikawa T, Sato Y, Isono S. Dynamic behavior of the soft palate during nasal positive pressure ventilation under anaesthesia and paralysis: comparison between patients with and without obstructive sleep-disordered breathing. Br J Anaesth. 2018;120:181–7.

    CAS  Article  Google Scholar 

  12. 12.

    White AA 3rd, Panjabi MM. Clinical biomechanics of the spine. 2nd ed. Philadelphia: JB Lippincott; 1990. p. 314–7.

    Google Scholar 

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Acknowledgements

The authors thank the radiological technicians at the Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan, for taking radiographs in the operation room.

Funding

This work received only departmental funding.

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Authors

Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by AS and GO. The first draft of the manuscript was written by Atsushi Sawada, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atsushi Sawada.

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The authors have no conflicts of interest to declare.

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Sawada, A., Ochiai, G. & Yamakage, M. A two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position for immobilization of the cervical spine. J Anesth (2021). https://doi.org/10.1007/s00540-021-02981-1

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Keywords

  • Two-handed airway maneuver
  • Mandibular advancement
  • Mouth opening
  • Neutral neck position