Airway patency in children undergoing magnetic resonance imaging using neck collars: a single center, randomized, double-blind, prospective study

Yilmaz, Gulseren; Varol, Kenan; Esen, Osman; Kayhan, Arda; Salihoglu, Ziya

doi:10.1016/j.bjane.2020.12.002

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Brazilian Journal of Anesthesiology

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Sumário

Clinical Research • para Braz. J. Anesthesiol. 71 (1) • Jan-Feb 2021 • https://doi.org/10.1016/j.bjane.2020.12.002 copy

Airway patency in children undergoing magnetic resonance imaging using neck collars: a single center, randomized, double-blind, prospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives:

Maneuvers precluding the downward shift of the mandibula and providing slight extension of the head have been shown to increase upper airway dimensions. This study aimed to investigate the role of Neck Collars (NC) in maintaining airway patency during Magnetic Resonance Imaging (MRI) examination in a pediatric population aged between 0 and 16 years.

Methods:

One hundred twenty-five children were recruited in this prospective study. Subjects were randomly assigned to NC group (NC+) or standard imaging group (NC-). Measurements of anteroposterior and transverse dimensions and cross-sectional area were performed to determine the upper airway size at three distinct levels: soft palate, base of the tongue, and tip of the epiglottis.

Results:

The anteroposterior diameter and cross-sectional area at the levels of base of the tongue and soft palate were significantly higher in NC+ patients compared to NC- patients. However, anteroposterior dimensions and cross-sectional areas at the epiglottis level were similar in the two groups. When patients were analyzed according to age groups of 0-2, 2-8, and 8-16 years, the anteroposterior diameter and cross-sectional area at the levels of base of the tongue and soft palate were significantly higher in NC+ patients compared to NC- patients in all age groups.

Conclusions:

This study clearly demonstrates that the application of a NC may improve retropalatal end and retroglossal airway dimensions in a pediatric population undergoing MRI examination and receiving sedation in supine position.

KEYWORDS
Airway; Children; Magnetic resonance imaging; Deep sedation

	NC- (n = 61)	NC+ (n = 64)	p-value
Age, years	3.6 ± 2.3	3.8 ± 2.4	0.584^a a p-value is the result of the Student t-test.
Gender, male (%)	34 (55.7%)	36 (59.0%)	0.769^b b p-value is the result of the Chi-square test.
Height, cm	96 ± 14	98 ± 14	0.283^a a p-value is the result of the Student t-test.
Weight, kg	15 ± 7	16 ± 10	0.396^a a p-value is the result of the Student t-test.
ASA physical status classification	1.9 ± 0.6	2.1 ± 0.6	0.067^a a p-value is the result of the Student t-test.
Induction time, min	3.1 ± 0.3	2.9 ± 0.7	0.063^a a p-value is the result of the Student t-test.
MRI time, min	21 ± 7	22 ± 6	0.279^a a p-value is the result of the Student t-test.
Recovery time, min	88 ± 13	85 ± 16	0.473^a a p-value is the result of the Student t-test.
Mean SBP, mmHg	94 ± 16	97 ± 14	0.296^a a p-value is the result of the Student t-test.
Mean DBP, mmHg	54 ± 15	57 ± 12	0.312^a a p-value is the result of the Student t-test.
Mean HR, n. min^-1	113 ± 16	107 ± 15	0.067^a a p-value is the result of the Student t-test.
Mean Sat O₂ (%)	94 ± 8	97 ± 5	0.003^a a p-value is the result of the Student t-test.
Base of the tongue
AP (mm)	8.9 ± 3.2	12.1 ± 3.6	< 0.001^a a p-value is the result of the Student t-test.
Transverse (mm)	11.1 ± 3.3	10.2 ± 3.6	0.229^a a p-value is the result of the Student t-test.
CSA (cm²)	0.81 ± 0.3	1.13 ± 0.4	0.012^a a p-value is the result of the Student t-test.
Soft palate
AP (mm)	10.9 ± 3.8	14.2 ± 4.1	< 0.001^a a p-value is the result of the Student t-test.
Transverse (mm)	5.5 ± 2.2	6.4 ± 2.5	0.074^a a p-value is the result of the Student t-test.
CSA (cm²)	0.62 ± 0.2	0.74 ± 0.3	0.042^a a p-value is the result of the Student t-test.
Epiglottis
AP (mm)	8.9 ± 3.2	8.9 ± 2.2	0.984^a a p-value is the result of the Student t-test.
Transverse (mm)	9.2 ± 4.1	10.1 ± 3.4	0.264^a a p-value is the result of the Student t-test.
CSA (cm²)	0.75 ± 0.4	0.71 ± 0.3	0.399^a a p-value is the result of the Student t-test.

	Age 0-2 years			Age 2-8 years			Age 8-16 years
	NC- (n = 18)	NC+ (n = 15)	p-value^a a p-value is the result of the Student t-test.	NC- (n = 29)	NC+ (n = 33)	p- value^a a p-value is the result of the Student t-test.	NC- (n = 14)	NC+ (n = 16)	p- value^a a p-value is the result of the Student t-test.
Base of the tongue
AP (mm)	8.4 ± 2.5	11.8 ± 3.3	0.001	8.9 ± 2.8	11.9 ± 3.5	0.048	9.1 ± 3.2	12.6 ± 3.9	0.010
Transverse (mm)	10.4 ± 3.1	9.9 ± 2.5	0.644	10.8 ± 2.9	10.3 ± 3.1	0.546	11.6 ± 3.3	10.7 ± 4.1	0.298
Area (cm²)	0.6 ± 0.2	1.0 ± 0.4	0.004	0.7 ± 0.3	1.0 ± 0.3	0.024	0.8 ± 0.4	1.1 ± 0.5	0.042
Soft palate
AP (mm)	10.7 ± 2.3	13.1 ± 4.6	0.019	10.9 ± 3.3	13.6 ± 4.6	0.009	10.9 ± 3.9	14.3 ± 4.1	0.001
Transverse (mm)	5.2 ± 1.4	6.7 ± 2.4	0.058	5.6 ± 2.8	6.8 ± 2.6	0.422	5.7 ± 2.6	6.5 ± 2.5	0.253
Area (cm²)	0.5 ± 0.4	0.7 ± 0.3	0.036	0.6 ± 0.2	0.8 ± 0.4	0.046	0.7 ± 0.2	1.0 ± 0.1	0.010
Epiglottis
AP (mm)	8.9 ± 3.8	8.9 ± 1.9	0.943	8.6 ± 3.7	8.9 ± 2.7	0.764	11.8 ± 6.4	8.9 ± 4.2	0.510
Transverse (mm)	8.9 ± 3.8	10.2 ± 2.9	0.283	9.0 ± 3.7	9.6 ± 3.1	0.754	9.2 ± 4.1	9.9 ± 3.5	0.461
Area (cm²)	0.7 ± 0.4	0.6 ± 0.3	0.419	0.7 ± 0.4	0.6 ± 0.5	0.396	0.8 ± 0.5	0.9 ± 0.3	0.785

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail: drgulseren83@gmail.com (G. Yilmaz).