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Determination of the appropriate oropharyngeal airway size in adults: Assessment using ventilation and an endoscopic view

Authors
 Hyun Joo Kim  ;  Shin Hyung Kim  ;  Ji Young Min  ;  Wyun Kon Park 
Citation
 AMERICAN JOURNAL OF EMERGENCY MEDICINE, Vol.35(10) : 1430-1434, 2017 
Journal Title
AMERICAN JOURNAL OF EMERGENCY MEDICINE
ISSN
 0735-6757 
Issue Date
2017
MeSH
Adult ; Aged ; Anesthesia, General* ; Bronchoscopy* ; Female ; Humans ; Intubation, Intratracheal* ; Male ; Middle Aged ; Oropharynx/pathology* ; Patient Positioning ; Respiration, Artificial* ; Retrospective Studies ; Sex Factors ; Young Adult
Keywords
Airway assessment ; Airway management ; Difficult airway algorithm ; Ventilation modes
Abstract
INTRODUCTION: Size 9 and 8 airways for men and women, respectively, have been proposed as most appropriate based on endoscopy. However, a limitation of this guideline is that ventilation was not assessed.

METHODS: In this retrospective review of prospectively collected data, 149 patients requiring tracheal intubation for general anesthesia were included. The adequacy for manual and pressure-controlled mechanical ventilation and views at the distal end of each airway was assessed using a fiber-optic bronchoscope with various airway sizes (7, 8, 9, 10, and 11).

RESULTS: For men, size 9, 10, and 11 airways permitted clear manual and adequate mechanical ventilation; size 7 and 8 airways caused partially obstructed manual and inadequate mechanical ventilation. On endoscopy, size 7 and 8 airways caused complete obstruction by the tongue; size 10 and 11 airways either touched or passed beyond the tip of the epiglottis. For women, the size 7 airway caused partially obstructed manual and inadequate mechanical ventilation; size 9 and 10 airways provided clear manual and adequate mechanical ventilation. The size 8 airway permitted clear manual ventilation, though mechanical ventilation was inadequate in one patient. On endoscopy, the size 7 airway caused complete obstruction in >50% of women; size 9, 10, and 11 airways either touched or passed beyond the tip of the epiglottis.

CONCLUSIONS: With respect to adequate ventilation in conjunction with an acceptable endoscopic view, size 9 and size 8 oropharyngeal airways appear to be the most appropriate sizes for clinical use in men and women, respectively.
Full Text
https://www.sciencedirect.com/science/article/pii/S0735675717302929
DOI
10.1016/j.ajem.2017.04.029
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Kim, Hyun Joo(김현주) ORCID logo https://orcid.org/0000-0003-1963-8955
Min, Ji Young(민지영)
Park, Wyun Kon(박윤곤)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160842
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