Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children.

Chin lift, jaw thrust and these manoeuvres combined with continuous positive airway pressure (CPAP) can be used to improve the patency of the upper airway during general anaesthesia. We used video endoscopy and measurement of stridor to compare the efficacy of these manoeuvres in 24 children (3-10 yr) with adenotonsillar hyperplasia. A bronchofibrescope was passed via the nose while the children were breathing spontaneously, to identify (i) the shortest transverse distance between the tonsils during inspiration and during expiration and (ii) the distance from the tip of the epiglottis to the posterior pharyngeal wall. Chin lift or jaw thrust lifted the epiglottis and, when combined with CPAP (10 cm H2O), there was a significant lateral displacement of the tonsils. Both chin lift plus CPAP and jaw thrust plus CPAP reduced stridor significantly compared with the unsupported condition. In conclusion, in spontaneously breathing children with large tonsils, chin lift plus CPAP is recommended, whereas jaw thrust plus CPAP is no better and may cause post-operative discomfort.